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AH" 

INAUGURAL  DISSERTATION 

ON    THE 

NATURE  AND  ORIGIN 

OF 

VACCINIA,    or  COW-POCK, 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION  OF  THE 

FACULTY  OF  PHYSIC 

UNaiia  THE  AUTHORITY  OF  THi:  TRUSTEES  OF  COLUMBIA  COLLECSi 
IN  THE  STATE  OF  NEW-YORK, 

The  Right  Rev.  BENJAMIN  MOORE,  D.D.  President; 

FOR  THE  DEGREE  OF 

DOCTOR  OF  PHYSIC, 

On  the  Sth  Day  of  November,  1803. 


BY  SAMUEL  SCOFIELD, 

Citizen  of  the  State  of  New- York. 


A  specific  is  discovered  for  that  disease  which  has  been  the  scourge 
of  Europe  for  a  thousand  years,  and  committed  the  most  dreadful 
ravages  in  every  quarter  of  the  world." 


N EW-rO  RK: 


Printed  by  T.  ^  J.  Swords,  Printers  to  the  Faculty  of  Physi' 
of  Cclumbia  CoUege.  ^  4    " 


1803. 


^:^ 


■S2>.3j$ 


TO 

"  \^ALENTINE  SEAMAN,  M.D,  8(c, 

WHOSE  HUMANE  AND  PHILANTHROPIC  EXERTIONS, 

so  CONSPICUOUSLY  DISPLAYED 

IN  INTRODUCING  AND  CULTIVATING  A  FAMILIAR 

KNOWLEDGE  pF  VACCINE  INOCULATION 

IN  THIS  CITY, 

.     -       '■     HAVE  JUSTLY  ENTITLED  HIM  TO 

THE  GRATEFUL  THANKS  AND  ESTEEM 

'-^'  OF  HIS  FELLOW  CITIZENS; 

AND 

IfO  WHOSE  A'ri'ENriVE  AND  INStRUCflVE  INFORMA'TlON 

fHE  AVfHOR  IS  JNDEBT'ED  FOR  fHE  GREATER 

PARI' OF  HIS  MEDICAL  EDUCAT'ION, 

THIS    DISSERTATION 

IS  RESPECTFULLY  INSCRIBED. 


*5 

James  WATSON,  Esq.  President; 
GILBERT  ASPINWALL,  Vice-President; 
THOMAS  FRANKLIN,  Treasurer; 
ADRIAN  HEGEMAN,  Secretary; 

AND    TO 

ROBERT  BOWNE,  WILLET  SEAMAN, 

JOHN  KEESE,  SAMUEL  MILLER, 

SAMUEL  L.  MITCHILL,  JAMES  ROBERTSON, 
ANDREW  COCK,  THOMAS  BUCKLEY,  and 

WILLIAM  MOORE,  ISAAC  HICKS,  Directors; 

AND    ALSO    TO 

VALENTINE  SEAMAN,    WRIGHT  POST,  and 
EDWARD  MILLER,  SAMUEL  BORROWE, 

Medical  Board  of  the 

Nexv-Ycrk  Institution  for  the  Inoculation  of  the 

Kine-Pock  : 

Gentlemen, 

PERMIT  me  to  tender  you  my  grateful 
and  sincere  acknowledgments  for  the  polite  attention 
shown,  and  for  the  many  services  rendered  me,  during  my 
official  capacity  as  Resident  Surgeon  to  that  Benevolent 
Institution :  And,  with  wishing  that  you  may  long  con- 
tinue your  wise  and  judicious  Guardianship  over  this  Bene- 
ficent Establishment,  in  v/hich  you  have  so  transcendently 
signalized  yourselves  in  the  glorious  cause  of  Humanity, 
and  more  particularly  as  respects  that  of  the  poor  and 
needy  of  your  ow^n  city,  I  subscribe  myself  your  much 
obliged  and  humble  servant, 

SAMUEL  SCOFIELD. 


INTRODUCTORY  OBSERVATIONS. 


J.  HE  subject  to  which  I  have  devoted  the  following 
pages  is,  I  conceive,  one  of  the  most  important  that  can 
engage  the  attention  of  the  medical  practitioner  or  of  the 
public.  It  is  not  only  intimately  connected  with  the  in- 
terests and  policy  of  States  and  Empires,  but  involves  in 
its  consequences  the  health  and  happiness  of  all  posterity. 

Not  more  than  five  years  have  elapsed  since  the  asto- 
nishing effects  of  this  inestimable  blessing  were  made 
known  to  the  world,  by  its  first  great  inoculator.  Dr. 
Jenner,  in  a  work,  entitled,  ^'  An  Inquiry  into  the  Causes 
and  Effects  of  the  Variola  Vaccina,  a  Disease  discovered 
in  some  of  the  Western  Counties  of  England,  particularly 
Gloucestershire,  and  known  by  the  Name  of  the  CoW" 
Foxr 

Notwithstanding  the  era  of  this  great  and  ever  memo- 
rable improvement  in  the  science  of  medicine  is  fixed  at 
so  advanced  a  period  as  the  latter  end  of  the  eighteenth 
century,  its  existence  in  the  cow,  and  its  capability  of 
being  communicated  from  the  cow  to  the  human  subject, 
have  been  known,  in  some  of  the  dairy  countries  of  Eu- 
rope, from  time  immemorial.  In  such  of  the  European 
countries,  those  persons  to  whom  were  committed  the 
affairs  of  the  dairy  were  known  frequently  to  contract 


m 


(    vi"     ) 

very  disagreeable  and  troublesome  sores,  from  milking 
such  cows  as  happened  to  be  labouring  under  this  com-, 
plaint;  generally  manifesting  themselves  in  the  part  ex- 
posed to  the  infection,  as  the  hands  and  wrists.  Persons 
so  infected  were,  in  the  course  of  their  complaint,  most 
generally  affected  with  a  slight  ephemeral  fever,  after  the 
subsidence  of  which,  the  ulcers  in  a  short  time  cicatrized ; 
and  they  were  left  in  a  state  for  ever  after  unsusceptible 
of  the  small-pox,  either  by  inoculation  or  contagion. 
The  truth  of  this  is  confirmed  by  the  experience  of  ages. 
But  this  knowledge,  unfortunately  for  humanity,  was 
principally  confined  to  the  proprietors  and  domestics 
of  the  dairy;  it  being  well  known  by  them,  that  the 
existence  of  such  a  disease  among  their  cows,  if  public, 
greatly  depreciated  the  value  of  their  produce.  At  length, 
however,  the  immortal  Jenner,  by  finding  it  frequently 
impracticable  to  communicate  the  small-pox  to  such  as 
were  said  to  h^ve  previously  undergone  cow-pock,  turned 
his  attention  towards  it,  and,  by  a  long  series  of  accurate 
and  impartial  experiments,  in  transmitting  the  matter  from 
the  cow  to  the  human  subject,  by  means  of  inoculation, 
evinced,  beyond  all  possibility  of  doubt,  that  the  disease 
thus  induced  was  equally  effectual  in  securing  a  person 
from  the  variolous  complaint,  as  that  communicated 
immediately  from  the  cow  by  milking;  and  that  the 
matter  was  not  in  the  least  deprived  of  its  prophylactic 
virtue  from  having  passed  the  ordeal  of  the  human  system. 
Experience  now  fully  warrants  the  assertion,  that  through 
this  medium  the  infection  may  be  handed  down  to  poste- 
rity in  an  undegenerated  state,  and,  contrary  to  the 
opinion  which  Dr.  Jenner  first  advanced,  will  supersede 
the  necessity  of  having  frequent  recourse  to  the  original 
stock,  in  order  to  keep  up  a  constant  supply  of  the  genuine 
matter. 


(     i>^     ) 

i^lthough  the  discovery  of  vaccine  inoculation  is  of  so 
very  recent  a  date,  and  notwithstanding  the  vast  torrent 
of  opposition  directed  against  it  from  almost  every  quarter, 
its  salutary  influence  has  already  extended  into  every 
civilized  nation  of  the  world,  and  its  beneficial  effects  are 
now  experienced  even  by  the  savage.  Indeed,  there  is 
not  at  present  a  single  well-informed  physician,  either  in 
Europe  or  America,  that  pretends  in  the  least  to  doubt  o£ 
its  efEcacy  in  protecting  the  system  against  that  loathsome 
complaint  the  small-pox.  It  is  computed  that  not  less 
than  two  millions  of  persons  have  already  experienced  the 
happy  effects  resulting  from  this  great  and  ever-memorable 
improvement.  A  great  proportion  of  the  better  informed 
part  of  the  community  have  already  become  sensible  of 
the  vast  benefits  that  would  accrue  to  society  In  substitut- 
ing the  vaccine  for  variolous  inoculation,  and  are  now  very 
generally  adopting  the  practice. 

From  the  growing  reput£.tIon  of  this  invaluable  disco= 
very,  we  are  warranted  in  asserting  that  it  promises  fair, 
at  no  very  distant  period,  to  exterminate  from  the  face  of 
the  earth  one  of  the  most  formidable  and  destructive 
maladies  to  which  mortality  is  heir ;  and  that,  in  time,  the 
small-pox  will  only  be  known  from  the  devastations  and 
ravages  which  It  has  committed — circumstances  which 
the  human  mind  will  ever  contemplate  with  horror. 

This  dreadful  scourge  of  humanity  is  not  only  to  be 
dreaded  in  regard  to  Its  fatality,  but  also  in  consequence 
of  the  many  incurable  diseases  which  it  not  unfrequendj 
produces;  some  of  the  most  prominent  of  which  I  shall 
take  an  opportunity  of  noticing  in  the  following  disser^ 
tation.  '  "  ^ 

B 


(       X       ) 

The  important  discovery  of  vaccine  inoculation  I  eon^ 
ceive  to  stand  unparalleled  in  the  history  of  medicine. 
What  remuneration,  what  gratitude,  then,  is  due  to  him 
who  put  mankind  in  possession  of  this  inestimable  bles- 
sing !  His  signal  and  transcendent  services  will  be  handed 
down,  in  the  annals  of  time,  to  the  latest  ages,  and  poste- 
rity will  recognize  the  name  of  their  great  benefactor  with 
gratitude  and  esteem. 


AN 

INAUGURAL  DISSERTATION 

ON 

VACCINA,    or   CO  TV-POCK. 


1  HE  Cow-pock  is  supposed^  by  Dr.  Jenner^ 
to  derive  its  origin  from  the  horse.  This  singular 
opinion  will,  no  doubt^  appear  very  surprising 
to  many.  In  order,  therefore,  that  the  reader 
may  clearly  understand  upon  what  his  belief  is 
predicated,  I  shall,  previously  to  entering  into  an 
investigation  of  the  subject  myself,  give  the  opi- 
nion entertained  of  it  by  our  author  in  his  own 
words,  in  the  following  quotation  from  his  works, 
(See  his  Inquiry  into  the  Causes  and  Effects  of 
the  Variola  Vaccine^,  8zc,  p.  2 — 6.) 

'^  There  is  a  disease,''  says  Dr.  Jenner,  ^^  to 
which  the  horse,  from  his  state  of  domestication, 
is  frequently  subject.  The  farriers  have  termed 
it  the  grease.  It  is  an  inflammation  and  swelling 
of  the  heel,  accompanied,  at  its  commencement, 
with  small  cracks  or  fissures,  from  which  issues 
a  limpid  fluid,  possessing  properties  of  a  very 
peculiar  kind.  This  fluid  seems  capable  of  gene- 
rating a  disease  in  the  human  body  (after  it  has 


12 

iindergone  the  modification  I  shall  presently' 
speak  of,)  which  bears  so  strong  a  resemblance  td 
the  small-pox,  that  I  think  it  highly  probable  it 
may  be  the  source  of  that  disease. 

"  In  this  dairy  country  a  great  num.ber  of 
cows  are  kept,  and  the  office  of  milking  is  per= 
formed  indiscriminately  by  men  and  maid, ser- 
vants. One  of  the  former  having  been  appointed 
to  apply  dressings  to  the  heels  of  a  horse  affected 
with  the  malady  I  have  mentioned,  and  not  pay- 
ing due  attention  to  cleanliness,  incautiously 
bears  his  part  in  milking  the  cows^  with  some  of 
the  particles  of  the  infectious  matter  adhering  to 
his  fingers.  When  this  is  the  case,  it  frequently 
happens  that  a  disease  is  communicated  to  the 
C0WS3  and  from  the  cows  to  the  dairy  maids, 
which  spreads  through  the  farm  till  most  of  the 
cattle  and  domestics  feel  its  unpleasant  conse- 
quences. This  disease  has  obtained  the  name 
of  Coiv-Pqx.  It  appears  on  the  nipples  of  the 
cows,  in  the  form  of  irregular  pustules.  At  their 
first  appearance  they  are  commonly  of  a  palish 
blue,  or  rather  of  a  colour  somewhat  approaching 
to  livid,  and  are  surrounded  by  an  inflammation. 
These  pustules,  unless  a  timely  remedy  be  applied, 
frequently  degenerate  into  phagedenic  ulcers, 
which  prove  extremely  troublesome.  The  ani- 
mals become  indisposed,  and  the  secretion  of 
milk  is  much  lessened.  Inflamed  spots  now  be- 
gin to  appear  on  different  parts  of  the  hands  of 


•IB 

the  domestics  employed  in  milking,  and  sornc- 
times  on  the  wrists,  which  run  on  to  suppuration, 
first  assuming  the  appearance  of  small  vesications 
produced  by  a  burn.  Most  commonly  they  ap- 
pear about  the  joints  of  the  fingers,  and  at  their 
extremities ;  but  whatever  parts  are  affected,  if 
the  situation  will  admit,  these  superficial  suppu- 
i-ations  put  on  a  circular  form,  with  their  edges 
more  elevated  than  their  center,  and  of  a  colour 
distantly  approaching  to  blue.  Absorption  takes 
place,  and  tumours  appear  in  each  axilla.  The 
system  becomes  affected;  the  pulse  is  quickened: 
shiverings,  succeeded  by  heat,  general  lassitude, 
and  pains  about  the  loins  and  limbs,  with  vomit- 
ing, come  on.  The  head  is  painful,  and  the  pa- 
tient is  now  and  then  even  affected  with  deli- 
rium.* These  symptoms,  varying  in  their  degrees 
of  violence,  generally  continue  from  one  day  to 
three  or  four,  leaving  ulcerated  sores  about  the 
hands,  which,  from  the  sensibility  of  the  parts, 
are  very  troublesome,  and  commonly  heal  slowly, 
frequently  becoming  phagedenic,  like  those  from 
whence  they  sprung.  During  the  progress  of  the 
disease,  the  lips,  nostrils,  eye-lids,  and  other  parts 
of  the  body,  are  sometimes  affected  with  sores; 
but  these  evidently  arise  from  their  being  heed- 
lessly rubbed  or  scratched  with  the  patient's  in- 

*  "  It  will  appear  in  the  sequel  that  these  symptoms  arise  principally 

Trom  the  irritation  of  the  sores,  and  not  from  the  primary  action  of  the  •■ 

Vaccine  virus  upon  the  constitution." 

Note  of  Dr.^-^nncr. 


14 

fected  fingers.  No  eruptions  on  the  skin  liaV^ 
followed  the  decline  of  the  feverish  symptoms  in 
any  instance  that  has  come  under  my  inspection^ 
one  only  excepted^  and  in  this  case  a  very  few 
appeared  on  the  arms:  they  v/ere  very  minutej 
of  a  vivid  red  colour^  and  soon  died  away  with- 
out  advancing  to  maturation;  so  that  I  cannot 
determine  whether  they  had  any  connection  with 
the  preceding  symptoms. 

"  Thus  the  disease  makes  its  progress  from  the 
horse  (as  I  conceive)  to  the  nipple  of  the  cow,  and 
from  the  cow  to  the  human  subject/' 

In  regard  to  this  interesting  subject,  I  shall 
take  the  liberty  of  deviating  from  its  worthy  au- 
thor. Sorry  I  am,  however,  to  contest  the  opinion 
of  so  eminent  and  learned  a  character;  but  can- 
dour, and  a  firm  persuasion  of  a  contrary  belief, 
compel  me  to  the  disagreeable  task. 

The  facts  which  I  conceive  greatly  to  militate 
against  Dr.  Jenner's  hypothesis  are, 

1.  That  the  Cow-pock  has  been  discovered  in 
the  teats  of  American  cows,  and  also  in  those  of 
several  parts  of  Europe,  where,  it  is  known,  the 
cows  and  horses  are  never  attended  by  the  same 
person. 

It  appears  that  Dr.  Jenner  has  an  opinion 
that  the  disease  is  particularly  confined  to  some 
few  counties  2*72  England,  where  there  is,  as  he 
says,  a  direct  communication  between  the  heels 
of  the  horse  and  the  teats  of  the  cow,  through 


15 

rhe  medium  of  the  male  domestics,  who,  after 
having  been  employed  in  applying  dressings  to 
the  heels  of  a  horse  affected  with  grease,  with- 
out proper  attention  to  cleanliness,  incautiously 
bear  their  part  in  milking  the  cows 3  and  in  this 
manner,  from  some  of  the  particles  of  the  infec-? 
tious  matter  having  adhered  to  their  fingers,  they 
communicate  the  disease  to  the  cows ;  and  that 
from  the  cows  it  is  communicated  to  the  maid- 
servants, and  in  this  way  spreads  through  the 
farm.  From  this  it  seems  that  Dr.  Jenner  lays 
his  chief  stress  on  the  circumstance,  as  he  sup- 
poses, of  the  disease  not  existing  in  any  country 
where  this  communication  "is  wanting.  Now, 
that  the  genuine  Cow-pock  has  been  discovered 
on  the  teats  of  American  cows,  in  several  of  the 
different  States,  is  an  undeniable  fact;  and  expe-^ 
rience  has  proved  that  the  matter  affords  effectual 
security  against  the  small-pox.  And  that  the 
office  of  milking  is  never  performed  by  men  that 
are  employed  in  applying  dressings  to  Xh^  greasy 
heels  of  a  horse  is  equally  certain.  It  is  also 
well  known,  that  the  Cow-pock  has  existed  in 
Ireland  from  time  immemorial,  where  it  is  even 
deemed  a  disgrace  for  a  man  to  engage  in  milk^ 
ing.  In  proof  of  which  I  shall  relate  the  fol- 
lowing anecdote,  which  Mr.  Ring,  in  his  treatise 
on  the  Cow-pock,  informs  us  was  related  to  him 
by  Dr.  Jenner  himself.  "  Two  peasants,  who 
lived  on  a  nobleman's  estate  in  Ireland^  having 


16 

been  compelled  to  milk  the  cows  in  the  park^ 
were  considered,  by  their  neighbours  and  fellow 
servants,  as  utterly  unfit  for  all  society.  Had 
they  committed  murder,  they  might  have  found 
some  kind  friend  to  speak  to  them  and  associate 
with  them;  but  they  had  been  guilty  of  a  much 
greater  crime,  that  of  milking  cows^ 

One  of  Dr.  Jenner's  principal  arguments  in 
support  of  his  opinion,  concerning  the  origin  of 
the  Cow-pock,  as  advanced  in  his  ^  Further  Ob-f 
3ervations  on  the  Variolas  Vaccinae,'  is  drawn 
from  the  supposed  "  total  absence  of  the  disease 
in  Ireland  and  Scotland,  where,"  he  says,  "  the 
men-servants  are  not  employed  in  the  dairy." 
It  appears  from  Mr.  Ring,  that  the  preceding 
narrative  was  related  by  Dr.  Jenner  previous  to 
his  knowledge  of  the  existence  of  the  disease  in 
these  countries.  '  Since  this,  however,  we  havQ 
been  informed,  by  men  of  the  first  respectability 
in  the  medical  profession,  that  the  Cow-pock 
has  existed  in  Ireland  for  an  undeterminate 
length  of  time ;  and  that  it  has  been  long 
known,  among  the  common  people  of  that 
country,  to  prove  effectual,  when  taken  froni 
the  cow  by  milking,  in  preventing  the  small- 
pox; instances  of  which  are  related  of  thirty  ox 
forty  years  standing:  and  there  are  not  wanting 
instances  of  persons  voluntarily  giving  themselves 
the  disease,  from  a  conviction  that  it  would  pre- 
vent the  small-pox. 


17 

'■■'  Doctor  Lewis  Sacco,  of  Milan/  in  his  treatise 
on  Cow-pock,  informs  us  that  he  has  di:covered 
the  real  disease  in  the  cows  of  Lombardy,  where 
the  horses  and  the  affairs  of  the  dairy  are  never 
attended  to  by  the  same  person.  And  it  has  alsQ 
been  discovered  in  the  Dutchy  of  Holstein. 

Now,  the  existence  of  the  disease  in  places 
where  it  is  certain  there  is  not  the  necessary  me-? 
dium  of  conveyance,  amounts  to  a  direct  proof, 
as  I  conceive,  that  the  Vaccina  is  not  in  any  way 
connected  with  or  dependent  on  the  grease. 

2.  It  does  not  appear  that  Dr.  Jenner,  or  any 
of  the  advocates  for  his  opinion,  have,  after  nu- 
merous and  repeated  experiments,  succeeded  in 
securing  the  system  against  the  effects  of  the 
variolous  virus,  either  with  matter  taken  immcr 
diately  from  the  horse,  or  after  it  had  undergone 
that  peculiar  modification  in  the  system  of  the 
cow  which,  by  Dr.  Jenner,  is  deemed  so  essen- 
tially requisite,  in  order  that  it  should  possess  the 
property  of  completely  securing  the  constitutiou 
against  the  effects  of  small-pox. 

It  is  said,  indeed,  by  Dr.  Jenner,  that  a  vete- 
rinary surgeon  has,  at  last,  actually  succeeded  in 
producing  the  disease  artificially  in  a  cow,  by 
removing  a  scab  from  the  teat,  and  applying  the 
recent  blackish  matter  of  grease  to  the  denuded 
surface.  This  is  the  only  case  he  relates  that 
appears  to  cari-y  with  it  the  least  degree  of 
proof  that    the    Cow-pock    derives    its    origii| 


18 

from  the  matter  of  grease ;  and  even  here  it 
seems  very  singular  that  we  have  not  a  more 
fall  history  of  the  case  given  us,  as  it  would 
certainly  be  of  the  utmost  consequence  to  have 
an  accurate  description  of  the  appearances  of  the 
disease,  and  also  what  use  was  made  of  the 
matter  it  afforded,  and  whether  it  imparted  to 
the  human  system  the  same  security  as  the  casual 
Cow-pock.  I  apprehend,  however,  there  were 
never  any  trials  instituted  with  this  artificial 
virus ;  or,  if  there  were,  they  must,  no  doubt, 
have  proved  abortive,  otherwise  so  important  a 
circumstance  in  support  of  the  doctrine  would 
doubtless  not  have  passed  unobserved. 

There  are,  it  is  true,  several  experiments  re- 
lated by  Dr.  Jenner,  which,  in  some  measure, 
seem  to  favour  his  hypothesis.  He  informs  us^ 
in  one  of  these,  that  he  found  it  impracticable 
to  induce  the  small-pox  in  a  person  who,  six 
years  previous  to  his  inoculating  him  with  va- 
riolous matter,  had  been  pretty  severely  indis^ 
posed,  owing  to  some  sores,  occasioned,  at  that 
time,  by  the  matter  of  grease.  This  person,  it 
is  said,  was  inoculated  repeatedly,  and  also  ex- 
posed to  variolous  contagion,  but  wthout  pro^ 
ducing  any  effect.  To  this  case  is  annexed  a 
note,  stating,  as  a  remarkable  fact,  well  known 
to  many,  the  frequent  failure  of  attempts  to  com- 
municate the  small-pox,  by  inoculation,  to  black' 
gmiths^  who  in  the  country  are  farriers. 


19 

Anotlier  case  Is  adduced  by  Dr.  Jenner^  to 
prove  the  obscure  appearance  of  small-pox  after 
the  disease  produced  by  the  grease^  at  least  in 
some  instances. 

In  another  he  tells  us  that  this  cannot  be 
entirely  relied  on,  until  a  disease  has  been  gene- 
rated, by  morbid  matter  from  the  horse,  on  the 
udder  of  the  cow,  and  passed  through  this  me- 
dium to  the  human  subject;  for  the  person  who 
Was  the  subject  of  this  case^  he  informs  us,  took 
the  small-pox  upwards  of  twenty  years  after- 
wards. 

In  all  these  cases  we  see  there  is  but  one  in 
which  the  person  was  rendered  unsusceptible  of 
the  small-pox,-  and  this,  it  seems,  was  only  of 
six  years  standing :  whereas  there  is  one  of  them, 
who,  after  twenty  years  had  elapsed,  was  seized 
with  the  variolous  disease.  Is  it  not,  therefore, 
probable,  that  the  person  who  continued  to  re* 
sist  the  small-pox  only  for  the  short  space  of  six 
years,  might  have  become  again  subject  to  it, 
after  a  lapse  of  thirty  or  forty?  Certainly  it  is 5 
and  the  more  so,  I  think,  as  there  is  but  this  one 
person,  among  the  many  adduced,  who  remained 
unsusceptible  of  variolous  action. 

Suppose,  for  a  minute,  it  be  admitted,  merely 
for  argument  sake,  that  the  equine  virus  possesses 
the  power  of  giving  to  the  system  complete 
security  against  the  small-pox.  Would  such  a 
fact  go  an)'  length  to  prove  its  similarity  to  Cow- 


2D 

pock?  Certainly  not.  For  It  must  be  knov^^h  td 
every  inoculator  of  experience,  that  it  is  fre- 
quently impracticable  to  excite  the  small-pox  in 
the  systems  of  those  who,  at  the  time  of  inocula- 
tion, happen  to  be  labouring  under  some  peculiar 
morbid  affection,  as  eruptive  complaints,  &Ci 
And  have  we  not  reason  to  suppose  that  there 
are  other  morbid  poison  S3  which  future  expe^ 
rience  may  prove  capable  of  warding  off  the 
effects  of  this  terrible  hydra  the  small-pox,  and 
perhaps  of  some  more  disagreeable  malady? 
The  Small-pox  and  Vaccina,  we  well  know^ 
are  capable,  in  a  great  measure^  if  not  entirely, 
of  mutually  destroying  the  eifects  of  each 
other,  at  least  their  constitutional  effect :  but 
110  one,  I  presume,  will  from  this  contend  for 
the  identity  of  the  two  diseases.  It  is  also  ren- 
dered pretty  certain,  from  experience,  that  the 
action  of  Vaccina  has  the  effect  of  rendering 
sheep  unsusceptible  of  a  very  fatal  complaint^ 
which  prevails  and  is  contagious  among  them, 
called  the  rot^  and  also  of  inducing  a  disease  in 
the  canine  species,  which  is  succeeded  by  art 
unsusceptibility  of  the  hydrophobia s  yet  no  one^ 
I  am  fully  persuaded,  will  imagine  the  least 
analogy  between  these  complaints. 

Another  very  potent  argument  in  favour  of  th6 
one  complaint  not  being  produced  by  the  other^ 
is  their  perfect  dissimilarity,  as  existing  in  these 
two  different  species  of  animals.     The  truth  of 


2i 

this  assertion,  I  am  convinced,  will  appear  at 
once  evident  to  every  person  who  has  had  an 
opportunity  of  examining  them  in  their  different 
stages.  It  is  said  by  those  vv^ho  are  conversant 
with  the  complaint,  that  the  grease  is  produced 
from  horses  standing  a  greal  length  of  time  in 
foul  stables;  moreover,  it  seems  to  be  confined 
principally  to  the  heels  of  the  animal,  evidencing 
itself  in  the  form  of  small  fissures  or  cracks: 
whereas  the  distempet  to  which  the  cow  is  sub- 
ject manifests  itself  on  the  udder,  assuming  a 
vesicular  or  pustulous  form.  Is  it  not  probable 
that,  if  these  diseases  were  of  an  analogous  na- 
ture, there  would  be  an  identity  of  their  appear- 
ance, when  affecting  only  different  species  of  the 
same  common  class  of  animals?  And  more  than 
this,  the  permanency  of  their  very  different  situa- 
tions in  these  animals  certainly  evince  a  very  de- 
cided difference  in  the  nature  of  them. 

The  validity  of  Dr.  Jenner's  opinion  relative 
to  the  origin  of  Vaccina  is  supposed,  by  many, 
to  be  completely  confirmed  by  some  experiments 
lately  made  by  a  Dr.  Loy,  who  tells  us  that,  in 
order  to  ascertain  the  truth  of  Dr.  Jenner's  asser- 
tion, he  had  recourse  to  experiments;  and  he 
informs  us  that  he  has  been  successful,  in  some 
few  of  the  great  number  he  has  made  with  the 
matter  of  grease,  in  exciting  a  disease  in  the 
human  constitution  which  very  much  resembled 
Vaccina,  and  which,  in  some  instances,  served 


as  a  complete  security  against  the  varioi6ii§ 
complaint  by  inoculation.  But  in  every  case  in 
•which  it  appears  to  have  been  successful  in  pre- 
venting variolous  inoculation  from  having  effect^ 
the  person  was  subjected  to  inoculation  with 
small-pox  before  the  disease  excited  with  the 
matter  of  grease  had^  by  any  means,  completed 
its  progress.  Some  of  them,  it  seems,  were  in- 
oculated with  small-pox  on  the  sixth  day  of  the 
disease,  others  on  the  tenth,  &c.  I  am  fully 
convinced  that  experiments  like  these  are  not  to 
be  depended  on,  more  especially  when  Dr. 
Jenner  tells  us,  that  he  has  witnessed  a  case^ 
where  a  person,  after  having  received  the  in^ 
fluence  of  grease,  remained  for  twenty  years 
unsusceptible  of  the  small-pox,  and  was  theii 
seized  with  this  complaint:  and  it  must  be  appa- 
rent, I  think,  to  every  person  at  all  acquainted 
with  the  physiological  laws  of  the  animal  ceco^ 
nomy,  that  a  morbid  disposition  would  not  so 
soon  become  extinct  from  the  system.  Further^ 
Dr.  Jenner  states  that  a  cold  and  wet  spring  is 
favourable  to  the  production  of  both  Cow-pock 
vca^  grease;  which  is  to  say,  that  the  former  is 
not  dependent  upon  the  latter,  but  that  they  are 
both  the  common  effect  of  certain  physical 
causes. 

From  what  has  been  above  adduced,  I  think 
we  may  with  propriety,  and  with  every  appear- 
ance of  truth,  conclude,  that   the  two  diseases 


•23 

are  not  only  unlike  in  their  nature  and  appear- 
ence,  but  also  in  their  effects:  the  one  affording 
a  temporary  and  ineffectual  security  against  the 
small-pox,  the  other  a  permanent  and  effectual ; 
the  one  peculiar  to  the  cow,  the  other  to  the 
Jiorse, 


Of  the  principal  discriminating  and  characteristic 
Sj/mptoms  and  Marks  of  the  inoculated  Vac- 
d?ia,  together  zvith  its  incidental  Varieties; 
and  a  jDescription  of  the  spurious  Complaint, 

THIS  disease,  as  communicated  by  inocula- 
lion,  much  resembles,  in  its  commencement, 
the  small-pox.  At  the  end  of  the  second  or  be- 
ginning cf  the  third  day,  if  the  operation  proves 
successful,  (2.  e.  forty-eight  or  sixty  hours  from  the 
time  of  inserting  the  virus)  a  small  speck  of  in- 
flammation generally  manifests  itself  at  the  place 
of  inoculation;  this,  gradually  and  uniformly 
increasing,  for  the  most  part  in  the  course  of  the 
third  day,  becomes  much  more  conspicuous,  and 
most  generally  by  the  commencement  of  the 
fourth,  WQ  may  discover,  by  the  feel,  a  minute 
pimple,  elevating  itself  somewhat  above  the 
common  surface  of  the  skin,  with  a  slight  in- 
flammation circumscribing  its  base.  From  this 
time  it  gradually  increases  in  magnitude,  and  hj 


24 

the  termination  of  the  fifth  or  beginning  of  the 
sixth  day,  begins  to  assume  that  characteristic 
and  specific  appearance  which,  to  the  expe=^ 
rienced  eye,  so  obviously  and  so  happily  distin* 
guishes  it  from  that  direful  malady  the  small-pox. 
These  criteria,  however,  cannot,  in  every  case, 
as  early  as  the  fifth  or  sixth  day,  be  so  clearly 
discerned  by  the  naked  eye.  Hence  the  necessity 
of  using  magnifying  glasses  in  examining  the 
early  stages  of  this  complaint.  The  peculiar 
visible  features  of  Vaccina  consist,  principally, 
in  the  perfectly  regular  margin  and  beautifully 
circumscribed  form  of  the  vesicle;  having  its? 
surface  much  flattened,  with  an  evident  and  re- 
markable depression  in  its  center,  of  a  darker 
colour,  giving  it  the  appearance  of  elevated 
edges;  which  is  occasioned  by  the  cuticle  still 
adhering  in  that  spot  to  the  true  skin  underneath. 
Contrary  to  this,  the  small-pox  pustule,  by  the 
fifth  or  sixth  day,  begins  to  assum.e  an  irregular 
angulated  margin,  and  is  altogether  destitute  of 
that  flattened  surface  and  central  depression 
which  so  peculiarly  characterise  the  genuine 
Cow-pock  vesicle.  What  more  certainly,  if  pos- 
sible, distinguishes  the  vaccine  from  the  variolous 
pock,  is,  that  the  former  appears  to  be  an  entire 
congeries  of  small  vesiculae  or  cells,  so  that  in 
puncturing  the  common  vesicle  or  membrane 
surrounding  them,  it  requires  some  time  for  the 
virus  to  ooze  out ;  and  when  we  have  exhauste4 


25 

it  of  all  its  contents,  its  magnitude  appears  very 
little  diminished :  whereas  the  latter  consists 
merely  of  one  common  cavity,  and  upon  making 
a  single  puncture  into  it,  its  contents  are  imme- 
diately and  entirely  evacuated,  leaving  no  trace 
of  its  existence  behind,  except  the  flaccid  and 
relaxed  cuticle  which  had  previously  served  to 
contain  the  matter.  It  is  peculiarly  deserving  of 
notice,  that  the  circumscribed  appearance  and 
perfectly  regular  margin  of  the  Cow-pock  vesicle 
are  evident  in  all  the  latter  stages  of  the  disease, 
even  in  the  process  of  scabbing:  while  the  small- 
pox, in  contra-distinction,  becomes  daily  more 
and  more  irregular,  in  consequence  of  the  con- 
fluence of  the  circumjacent  pustules. 

About  the  fifth  or  sixth  day,  and  in  some  in- 
stances  as  early  as  the  fourth,  the  inoculated  part 
begins  to  change  from  the  red  pimple  above 
mentioned,  assuming  a  vesiculated  appearance, 
containing  a  fluid,  the  colour  of  which,  through 
the  cuticle,  resembles  very  much  that  of  whey, 
being  of  a  perfectly  limpid  consistence,  and  very 
transparent.  Its  limpid  consistency  and  transpa- 
rency, however,  are  apt,  from  certain  causes,  to 
undergo  a  considerable  change,  which  we  shall 
take  occasion  hereafter  to  mention.  It  is  at  this 
period  that  the  virus  possesses  its  greatest  share 
of  activity,  and,  provided  it  can  be  obtained  in 
sufficient  quantity,  is  most  suitable  for  the  pur-? 
poses  of  vaccination  3  it  being  at  this  early  stag© 

D 


26 

of  the  complaint,  for  the  reason  above  mentioned, 
less  liable  to  fail  in  exciting  the  disease  than  if 
delayed  to  a  later  day ;  though  from  the  sixth  day 
to  the  tenth  is  laid  down,  by  Dr.  Jenner,  as  the 
most  proper  time  for  procuring  it.  During  the 
tim.e  that  intervenes  between  these  two  periods 
the  pustule  is  greatly  augmented,  so  much  so  by 
the  tenth  day,  in  the  generality  of  well-marked 
cases,  as  to  acquire  nearly  the  size  of  a  half-dime; 
the  surface  of  the  pock  at  the  same  time  becom- 
ing much  more  evidently  flattened,  in  proportion 
as  it  increases,  so  that  sometimes,  in  a  pock  of  the 
above  mentioned  magnitude,  its  elevation  above 
the  surface  of  the  surrounding  skin  will  scarcely 
exceed  the  one-tenth  of  an  inch :  the  genuine 
vaccine  vesicle  is  likewise  always  destitute  of 
that  plump  rotundity  which  is  so  invariable  an 
attendant  on  the  variolous. 

About  the  eight  or  ninth  day,  sometimes  a 
little  earlier  or  later,  according  to  circumstances, 
the  pock  having  attained  to  its  acme,  the  consti- 
tutional  symptoms  begin  to  manifest  themselves, 
first  by  pain  in  the  inoculated  part,  extending 
itself  towards  the  axilla,  the  glands  of  which 
now  become  swelled  and  painful,  especially  on 
making  any  exertion  with  the  arm.  These  symp- 
toms having  extended  themselves  thus  far,  the 
whole  system  begins  now  to  participate  in  the 
affection,  by  association  with  the  local  part; 
as  evinced  by  the  succeeding  languor,  drowsiness^, 


m 

paleness,  chilliness,  flushes  of  heat,  head-ache^ 
fulness  and  pain  of  the  eyes,  with  redness ;  pain 
of  the  limbs  and  back,  loss  of  appetite,  nausea, 
and  sometimes  vomiting;  increased  fulness  and 
preternatural  frequency  of  the  pulse,  thirst,  white 
tongue,  and,  in  short,  all  the  general  symptoms 
of  fever.  It  is  not,  hov/ever,  to  be  supposed 
that  these  symptoms  discover  themselves  in  every 
case;  on  the  contrary,  it  frequently  happens  that 
w^e  are  unable  to  perceive  the  least  constitutional 
indisposition:  some  of  these,  for  the  most  part, 
notwithstanding,  make  their  appearance,  con- 
tinuing from  a  few  hours  to  one,  two,  or  three 
days,  according  to  the  constitution  of  the  patient, 
together  with  many  collateral  circumstances; 
then  subsiding  spontaneously  without  any  dis- 
agreeable consequence.  The  slight  marginal  in- 
flammation which  has  remained  permanent  from 
the  first  commencement  of  the  vesicle  beo^ins, 
about  the  eighth  or  jiinlh  day,  sometimes  rather 
earlier  or  later,  gradually  to  extend  itself,  very 
moderately  affecting  the  surrounding  parts,  till 
about  the  iejith  ox  eleventh,  when  its  increase  be- 
comes much  more  rapid;  diffusing  itself,  in  some 
instances,  to  the  distance  of  two  or  three  inches 
from  its  source,  and  sometimes,  though  rarely, 
extending  itself  as  high  up  as  the  shoulder  and 
as  low  down  as  the  elbow.  This  it  is  that  con- 
stitutes the  efflorescence  or  areola  so  much  spoken 
pf  by  authors^  and  which  is  said,  hj  some,  to  be 


indicative  of  the  constitutional  affection,  and  by 
many  is  considered  as  a  pathognomonic  symptom 
of  the  complaint. 

From  this  time  the  central  depression  of  the 
vesicle  begins  to  assume  a  darker  appearance, 
which,   extending  itself  gradually  towards  the 
circumference,  completes,  in  the  course  of  four 
or  five  days,  that  dark  mahogany-coloured  scab 
which  is  so  peculiarly  characteristic  of  the  true^ 
disease.     This  scab,  if  it  be  minutely  examined 
in  the  first  stages  of  its  formation,  will  be  found 
very  frequently  to  put  on  a  stellated  appearance, 
having  a  number  of  small  lines,  like  radii,  shoot- 
ing out  from  the  center  to  the  circumference,  in 
a   curvilineal   direction;    with   a  corresponding 
number  of  little    sulci  or  furrows.     From    the 
£rst  commencement  of  the  scabbing  process  to 
its  completion,  the  scab  passes  through  all  the 
different  grades  of  colour,  from  a  light  brown 
to  that  of  a  dark  mahogany,  assuming,  at  last, 
very  much  the  colour  and  appearance  of  a  tama- 
rind stone;  becoming,   towards  the  latter  stages 
of  vaccination,  very  thick  and  heavy,  and  daily 
increasing  in    the  intensity  of   its  colour;   and 
gradually  detaching  itself,  at  its  circumference, 
from  the  surrounding  parts,  adheres,  at  length, 
by  nothing  but  its  center;  falling  oif  eventually 
at  different  periods  of  time,   though   generally 
in  three  or  four  weeks  from    that  of  inocula- 
tion 3  leaving  no  trace  of  its  existence  behind> 


<29 

except  a  superficial  pit  or  depression  in  the 
cuticle. 

Thus  does  the  Yaccine-pock,  as  it  has  occur- 
red to  me,  complete  its  regular  stages.  Some  va- 
rieties, however,  remain  yet  to  be  mentioned, 
which  I  shall  proceed  to  treat  of  in  the  follow- 
ing order. 

It  sometimes  happens,  that,  either  from  some 
peculiar  change  in  the  qualities  of  the  matter 
Used  for  inoculation,  or  from  some  specific  dis- 
position of  habit,  the  vaccine  vesicle  shall  varj 
in  respect  to  its  progress,  and  also  its  appear- 
ances, through  its  different  stages.  These  va- 
rieties resolve  themselves  principally  into  the 
three  following  heads:  1.  In  regard  to  the  pro- 
gress and  appearances  of  the  vesicle.  2.  In  re- 
gard to  the  areola  or  efflorescence:  and,  3.  As 
respects  the  scabbing  process. 

The  standard  or  natural  appearances  of  the 
Cow-pock  vesicle  are  those  above  related  :  in 
some  instances,  however,  notwithstanding  every 
precaution  is  used  in  the  operation,  as  well  as 
in  taking  and  preserving  the  infection,  the  disease 
induced  will  deviate  considerably  from  its  natural 
appearance.  The  virus,  in  some  cases,  after 
its  introduction  under  the  cuticle,  does  not  pro- 
duce any  evident  change  in  the  part  for  some 
time,  lying  apparently  in  a  dormant  or  latent 
state  for  ten  or  fifteen  days,  when,  either  from 
a  second  inoculation,  or  some  other  cause,  it  be* 


S6 

comes  roused  into  action,  and  proceeds  oft 
through  its  regular  stages,  assuming  its  natural 
appearances;  though  its  progress,  in  such  cases, 
is  almost  always  much  more  rapid  than  usual. 
Several  instances  of  this  nature  I  had  an  oppor^ 
tunity  of  witnessing  during  my  residence  at  the 
New- York  Institution  for  the  Inoculation  of  the 
Kine-pock.  A  case  of  the  like  nature  also  oc- 
curred in  the  practice  of  a  very  respectable  phy- 
sician of  this  city,  which,  from  its  singularity,  1 
deem  Vi^ell  worth  mentioning.  The  virus,  in  this 
case,  after  its  insertion,  had  lain  apparently  in 
an  inactive  state  for  several  days,  when,  from 
an  inoculation  with  variolous  matter,  near  the 
place  where  the  vaccine  virus  had  been  intro-- 
duced,  it  was  excited  into  action,  and  passed 
regularly  through  its  several  stages,  entirely  su- 
perseding the  effects  of  variolous  inoculation^ 
although  the  latter  had  made  some  considerable 
progress.  This  person,  it  may  be  observed,  had 
been  repeatedly  vaccinated  by  Dr.  Waterhouse, 
of  Cambridge  College,  and  by  him  was  deemed 
unsusceptible  of  the  complaint.  Sometimes  the 
vesicle  is  very  tardy  in  its  progress,  and  does  not 
arrive  at  maturity  till  the  twelfth  or  fifteenth 
day;  it  being  very  obvious,  however,  that  the 
operation  had  taken  effect  immediately  after  the 
insertion  of  the  virus.  At  other  times,  again, 
the  vesicle  is  premature,  acquiring  its  acme  as 
early  as  the  sixth  or  seventh  day,  with  a  forma- 


SI 


tiDii  of  its  areola  proportionabiy  soon.  I  have 
obtained  matter,  which  answered  every  purpose 
of  inoculation,  as  early  as  the  fourth  day.  la 
some  cases  the  pock  produced  is  unusually  small. 
But,  notwithstanding  all  these  varieties  in  respect 
to  its  progress  and  size,  the  vesicle,  if  genuine, 
still  preserves  its  central  depression,  its  circular 
form,  regular  margin,  and,  in  short,  every  cha* 
racteristic  and  specific  appearance.  These  ano- 
malies, in  all  probability,  result  either  from  some 
peculiar  change  in  the  matter  made  use  of,  or  from 
the  system's  being  under  the  influence  of  some 
morbid  action.  Some  few  cases  I  have  seen,  in 
which  there  were  from  one  to  two  or  three  pock 
made  their  appearance  in  the  vicinity  of  the  local 
one,  exactly  resembling  it  in  every  particular  cir- 
cumstance, though  generally  falling  oiF  rather 
sooner.  This,  however,  is  by  no  means  a  com^ 
mon  occurrence;  and  when  such  pock  do  appear, 
they  are,  in  all  probability,  induced  by  the  pa- 
tient's infecting  the  part  with  his  nails. 

From  what  has  been  above  said,  it  will  be 
seen  that  the  vesicle  is  subject  to  great  variation, 
especially  as  regards  its  progress;  and  that,  there- 
fore, there  can  be  no  specific  time  fixed  upon 
for  procuring  the  virus.  I  have,  as  before 
stated,  obtained  it  as  early  as  the  fourth  day, 
(ninety-six  hours  from  the  time  of  inoculation) 
and  succeeded  perfectly  well  with  it  in  produce 
ing  the  real  disease.     In  other  cases,  on  the  coa- 


32 

trary,  it  has  been  impracticable  to  obtain  any  till 
the  tivelfth  or  fourteenth  day. 

It  has  been  observed,  in  the  foregoing  pages, 
that  a  slight  marginal  inflammation  was  present 
from  the  earliest  stage  of  the  complaint,  and  that, 
in  general,  this  began  to  diffuse  itself  to  the  sur- 
rounding parts  about  the  ninth  or  tenth  day, 
forming  what  is  called  the  efflorescence  or  areola. 
It  commonly  happens  that  this  inflammation  does 
not  diffuse  itself  in  the  form  of  an  areola  till  the 
period  above-mentioned:  cases,  however,  have 
occurred,  in  which  it  commenced  its  career  as 
early  as  the  ffth  or  sixth  day:  in  others,  again, 
it  has  not  made  its  appearance  till  the  tivelfth  or 
fourteenth  I  and  sometimes,  it  is  said,  not  at  all. 

The  efflorescence,  after  it  has  commenced,  ad- 
vances very  rapidly  to  its  height,  from  which  it 
begins  soon  gradually  to  decline,  first  at  its  circum- 
ference; and,  in  the  course  of  one,  two,  or  three 
days  at  farthest,  is  almost  entirely  gone;  being, 
in  general,  succeeded  by  a  desquamation  of  the 
cuticle.  Frequently,  however,  it  begins  first  to 
subside  from  around  the  base  of  the  vesicle, 
leaving  between  its  circumference  and  the  pock 
an  interval  of  uninflamed  surface,  and,  gradually 
advancing  from  this  towards  the  confines  of  the 
areola,  completely  disappears  in  the  usual  time. 
Sometimes  the  areola  subsides  in  such  a  manner 
as  to  leave  one  circle  of  inflammation  imme- 
diately around  the  base  of  the  pock,  and  another 


S3 

externally,  so  as  to  constitute  a  distinct  external 
and  internal  areola.  As  the  efflorescence  differs 
in  respect  to  its  time  of  appearance  and  mode  of 
declension,  so  also  does  it  vary  in  its  appearance 
when  formed.  It  has  before  been  stated,  that 
it  was  naturally  circumscribed  and  limited  in  its 
extent,  and  uniform  in  its  colour  from  the  vesi? 
cle  to  its  border:  these  characters,  however,  iri 
some  instances,  are  varied,  for  it  sometimes  hap-? 
pens  that  the  areola,  instead  of  exhibiting  this 
circumscribed  and  limited  extent,  assumes  a  stel« 
lated  appearance,  not  having  its  inflammation 
uniformly  diffused,  even  within  its  boundaries; 
but  having  alternately  a  streak  of  inflamed  and 
uninflamed  surface  shooting  out  from  the  vesicle, 
like  radii  from  a  center,  and  exhibiting  no  de- 
finite boundary, 

The  efliorescenee  varies  also  in  point  of  dura» 
tion,  its  usual  time  of  continuance  being  froni 
one  to  three  days;  though  it  frequently,  either 
from  mechanical  irritation,  or  from  the  natural 
tendency  of  the  disease,  continues  a  much  longer 
time, 

It  also  varies  as  to  its  intensity  of  colour,  being 
naturally  that  of  a  rose-pink;  though  in  some 
cases  it  is  of  the  colour  of  the  pink  only,  and  in 
0thers  of  a  Vermillion. 

Having  mentioned  the  varieties  that  are  oc- 
casionally manifested  in  the  vesicle  and  eflloresr 
i:ence,  I  shall  proceed  to  notice  some  of  the  mos^ 

E 


34 

usual  that  take  place  in  the  process  of  scabbhig, 
The  change  of  colour  which  is  to  be  observed  in 
the  center  of  the  vesicle  about  the  close  of  the 
tenth  day,  indicates  the  commencement  of  this 
process,  and  extends  itself  over  the  surface  of 
the  pock  in  the  course  of  two  or  three  days ; 
and  the  pock,  at  the  same  time,  gradually  har- 
dening, the  scab,  for  the  most  part,  is  completely 
formed  in  ten  days  or  two  weeks  from  the  time 
of  vaccination :  from  this  time  it  begins  gra- 
dually to  detach  itself  from  the  skin,  at  its  cir- 
cumference, and  shortly  falls  off,  leaving  the 
part  in  the  state  before  memioned.  It  some-- 
times  happens,  however,  contrary  to  this  natural 
state  of  affairs,  that  the  formation  of  the  scab 
commences  at  a  much  earlier  period,  and  some- 
times, again,  is  protracted  far  beyond  its  usual 
time.  It  has,  indeed,  been  known  to  commence 
as  early  as  the  sixth  or  seventh  day,  and  com-^ 
plete  itself  proportionably  soon:  in  other  cases 
it  has  not  commenced  till  the  seventeenth  or 
eighteenth,  though  in  such  it  has  been  observed 
to  advance  to  a  state  of  maturity  much  sooner. 
As  to  the  colour  of  the  scab  in  the  genuine  com- 
plaint, it  seldom  varies,  assuming  almost  inva^ 
riabiy  that  dark  brown,  chesnut,  or  mahogany- 
coloured  appearance,  heretofore  mentioned ;  at^ 
tended,  most  commonly,  with  a  smoothly  po- 
lished and  glossy  surface.  I  have  observed,  how^ 
^yer,  that  in  the  dark  skin  of  the  African  th^ 


-35 

toldu^  IS  more  intense  than  in  the  skin  of  ail 
iEuropean,  being  iniiuencedj  probably,  by  the 
colour  of  the  rete-mucosum.  The  other  charac- 
ters of  the  disease^  as  exhibited  by  the  former, 
are  altogether  synonymous  with  those  of  the 
latter,  except  the  aivola,  which  must,  of  course, 
be  invisible:  its  existence,  nevertheless,  is  fully 
evinced  by  that  tumid  hardness  which  is  so  in- 
variable a  concomitant  of  this  local  inflamma- 
tion. 

Having  now,  as  accurately  as  I  am  able,  de- 
lineated the  natural  appearances  of  the  genuine 
Vaccina,  and,  with  as  much  precision  as  the  ex- 
tent of  my  observations  would  permit,  traced  it 
through  its  different  anomalies,  I  proceed  to  men- 
tion some  of  the  most  obvious  and  discriminating 
characters  of  the  spurious  complaint. 

When,  from  mismanagement  in  either  taking 
or  preserving  the  genuine  vaccine  virus,  a  dete- 
rioration of  its  natural  and  inherent  properties  is 
induced,  instead  of  producing  that  beautiful  sym- 
metry of  appearances  above  described,  it  gives 
rise  to  a  disease  not  only  totally  unlike  it  in  ap- 
pearance, but  one  that  is  altogether  dissimilar  in 
effect;  which,  instead  of  affording  that  perma- 
nent and  effectual  security  against  the  small-pox 
ever  attendant  on  the  real  complaint,  is  entirely 
destitute  of  all  prophylactic  influence;  conse- 
quently, leaving  the  constitution  in  a  state  still 
susceptible  of  the  impression  of  variolous  virus. 


The  effect  thus  produced  not  answering  the  de* 
sired  expectation,  has  led  many  unwary  and  in- 
attentive physicians  to  allege,  that  vaccine  in- 
t)culation  was  not  succeeded  by  an  unsuscepti- 
bility  of  the  constitution  to  variolous  infection; 
Hence  vs^e  see  the  necessitv  of  indefatigable  and 
reiterated  experiments,  in  order  to  arrive  at 
truth,  in  conducting  such  novel  and  interesting 
inquiries. 

The  vesicle,  excited   by  spurious  or  impure 
virus,  is  very  readily  distinguished,  by  every  ex- 
perienced eye^  from  that  which  results  from  the 
real.    The  effect  of  the  former,  when  introduced 
under  the  cuticle,  is  frequently  to  excite  prema- 
ture inflammation,  attended,  in  many  instances, 
•with  intolerable  itching,  (this  symptom  is  also  a 
presage  of  its  not  having  taken  effect  at  all,  /.  e, 
"when  genuine  matter  is  used),  and  rnany  times 
producing  an  elevation  of  the  cuticle,  and  forming 
k  pimple  of  considerable  magnitude  in  the  course 
of  a  few  hours.     This,  however,  is  not  always 
the  case:  in  sorrie  instances  its  effects  do  not  be^ 
come  apparent  sooner  than  those  induced  by  the 
genuine  virus.     From  this  time  the  disease  pro- 
gresses through  its  different  stages;  not,  however, 
with    that  admirable    and    beautiful  regularity 
which  characterizes   the   true  disease.     When^ 
from  impure  virus  having  been  made  use  of,  the 
spurious  Cow-pock  is  induced,  instead  of  pre*- 
senting  itself  in  the  form  of  a  regular  and  cir^ 


27 

tumscr'ibed  vesicle,  it  has  the  appearance  of  an 
ill-conditioned  creeping  sore,  seldom  assuming 
the  pustulous  or  vesicular  form  ;  and  instead  of 
producing  a  scab  of  the  usual  kind,  is  attended 
with  a  festering,  light  coloured,  or  yellow  one, 
being  always  less  thick  and  heavy  than  that 
succeeding  the  true  disease. 

What  is  still  more  strikingly  different  is,  that 
the  scab  succeeding  the  genuine  vesicle  appears 
to  be  merely,  as  it  were,  laid  on,  or  slightly  ad- 
hereing  to  the  skin;  has  its  superior  surface  very 
level  or  plane,  and  its  margin,  or  external  cir- 
cumference, is  very  considerably  and  abruptly  ele- 
vated above  the  common  level  of  the  surround- 
ing parts:  whereas  the  scab  of  the  spurious  has 
considerable  rotundity,  is  thickest  in  the  middle, 
little  elevated  above  the  surface,  very  light  and 
thin  around  its  margin,  gradually  though  irre- 
gularly losing  itself  in  the  surrounding  skin,  and 
frequently  terminates  in  a  disagreeable  phage- 
denic ulcer,  difficult  of  cure.  The  spurious  pock, 
at  the  same  time,  has  no  regular  areola  or  efflo- 
rescence, but  merely  an  inflammation  surrounds 
ing  it,  which  frequently  extends  itself  to  a  con- 
siderable distance  from  the  place  of  inoculation, 
particularly  when  much  irritated,  putting  on  that 
angry  and  fiery  aspect  so  peculiarly  characteristic 
of  phlegmonic  or  suppurative  inflammation: 
whereas  the  real  pock  is  surrounded  by  an  ery- 
sipelatous inflammation.     This  inflammation  i§ 


also  much  more  permanent  than  the  efflorescence 
accompanying  the  true  Vaccina;  neither  is  it  so 
rapid  in  its  accession  or  declension  as  the  latter 
naturally  is. 

The  constitutional  affection  induced  by  this 
complaint  (especially  if  the  local  disease  proceeds 
to  any  great  height)  is  generally  more  severe  than 
that  which  is  attendant  on  the  real  disease.  The 
slight  symptoms  of  fever  that  usually  occur  in 
true  Vaccina  are  here  very  much  aggravated: 
the  patient,  for  the  most  part,  is  affected  with 
great  pain  and  swelling  in  the  axilla^  extreme 
pain  of  the  head,  preternatural  heat  of  the  sur- 
face, great  pain  in  the  bones  and  back,  pulse 
much  more  frequent  and  full  than  natural,  white 
tongue,  nausea  and  vomitings  great  pain  and 
tension  in  the  inoculated  part,  &c.  Besides, 
these  symptoms  have  no  stated  or  regular  time 
of  coming  on,  but  invade  the  system  indiscrimi- 
nately, as  circumstances  shall  direct. 

If  the  disease  succeeding  vaccination  shall  as^ 
sume  the  above  appearances,  no  one  need  for  a 
moment  hesitate  in  pronouncing  it  to  be  spu- 
rious; and  we  may,  with  boldness^  assert,  that 
it  has  not  wrought  that  requisite  change  in  the 
system  which  is  so  indispensibly  necessary  in 
order  to  secure  it  against  the  dire  effects  of  va- 
riolous poison. 

After  having  thus  briefly  treated  of  the  origin, 
general  appearances,  and  varieties  of  this  extra- 


S9 

ordinary  complaint,  I  deem  it  necessary  to  offer 
some  few  observations  in  regard  to  its  method  of 
treatment. 

From  the  foregoing  description  of  this  disease 
I  think  it  will  appear  very  generally  to  require 
more  attention  in  nice  discernmiCnt  and  discri- 
mination, in  order  to  detect  its  specific  and  cha- 
racteristic marks,  than  in  judging  of  medicines 
proper  to  be  prescribed.  I  believe  it  will  be  very 
readily  admitted,  by  every  experienced  practi- 
tioner in  this  complaint,  that  there  is  scarcely 
one  case  in  ten  in  which  the  patient  is  so  much 
indisposed  that  a  cooling  purgative  or  two^  joined 
with  a  little  abstinence  in  diet  and  regimen, 
will  not  relieve  him.  This,  I  can  say,  was  the 
ease  during  my  residence  at  the  Kine-Pock  Insti- 
tution of  this  city,  which  was  one  year,  in  which 
time  there  were  upwards  of  a  hundred  persons 
w^ho  experienced  the  salutary  effects  of  vaccine 
inoculation  at  that  benevolent  establishment,  and 
not  one  case  in  the  whole  number  presented, 
(notwithstanding  they  were  generally  of  the  more 
indigent  part  of  the  community,  consequently 
very  liable  to  be  exposed  to  all  the  vicissitudes 
of  weather,  and  many  of  them,  indeed,  to  labo- 
rious exercises,)  that  required  any  thing  more 
than  some  mild  and  cooling  cathartic. 

The  Cow- pock  has  been  objected  to,  by  many, 
from  an  ill-founded  idea  that  it  is  frequently  pro- 
4uctive  of  very  sore  arms.     Some,  indeed,  allege 


40 

that  the  ulcer  subsequent  to  vaccination  is  muck 
more  inveterate  and  difficult  of  cure  than  that 
induced  by  small-pox.  This,  hov^ever,  I  have 
never  found  to  be  the  case,  and  I  am  inclined  to 
believe  that  if  the  necessary  attention  be  paid  in 
removing  the  too  great  mechanical  irritation,  a 
great  proportion  of  v^hich  very  frequently  arises 
from  tight  sleeves,  and  in  giving  the  patient  the 
necessary  injunctions  not  to  scratch  or  irritate 
the  vesicle  (which,  by  the  bye,  he  is  very  much 
disposed  to  do,  ov^ing  to  the  intolerable  itching 
which  frequently  accompanies  the  areola,)  it  will 
be  found  a  very  seldom  sequela  of  the  true  pock. 
Sometimes,  however,  from  inattention  to  the 
above  precautions,  the  scab  is  rubbed  off,  or  the 
vesicle  very  much  irritated;  in  consequence  of 
which,  violent  inflammation  not  unfrequently 
ensues,  accompanied  with  great  tumefaction, 
which,  in  some  instances,  extends  itself  to  a 
considerable  distance  from  the  place  of  vac^ 
cination,  with  great  pain  in  the  inoculated 
part,  extending  towards  the  axilla;  to  which 
very  commonly  succeed  swelling  and  inflamma^ 
tion  of  the  axillary  glands,  restlessness,  chills, 
fever,  anxiety,  nausea,  vomiting,  head-ache,  pain 
of  the  back,  &c.  These  symptoms,  in  the  course 
of  two  or  three  days,  will  generally  disappear; 
though,  now  and  then,  a  case  of  greater  violence 
will  protract  itself,  as  alleged  by  some,  to  one, 
two,  and  even  three  weeks,     It  is  not  common. 


41 

however,  to  find  a  case  so  violent  as  not  speedily  to 
yield  to  a  gentle  antiphlogistic  treatment.  Due 
attention  should  also  be  paid  to  the  local  aifection^ 
which,  by  this  time,  has  commonly  assumed  the 
appearance  of  a  troublesome  phagedenic  ulcer. 
When  the  disease  shall  have  acquired  such  an 
augmentation  (which,  indeed,  it  appears  inca^ 
pable  of,  except  from  great  and  repeated  irrita^ 
tion  of  the  vaccinated  part),  it  is  highly  requi^ 
site  that  some  active  m.eans  should  be  resorted  to^ 
in  order  to  arrest  its  progress.  This  we  find  very 
effectually  answered  by  the  application  of  the 
unguentum  citrinuni;  care  being  taken,  however^ 
never  to  extend  its  use  beyond  the  surface  of  the 
ulcer,  otherwise,  if  active,  it  will  frequently  cor-? 
rode  the  skin,  and  by  this  means  augment  the 
sore.  The  unguentum  hydrarg.  and  the  un^ 
guent,  precip.  rubr.  are  frequently  very  service- 
able in  disposing  the  ulcer  to  heal.  In  milder 
cases,  the  aq.  lytharg.  or  Goulard's  extract  of 
Saturn,  diluted,  v/ill  generally  prove  eflfectual. 
When  the  inflammation,  pain  and  swelling  shall 
become  greatly  aggravated,  an  emollient  poul° 
tice  will  be  found  beneficial.  If  the  inflamma- 
tion and  sweUing,  at  the  same  time,  extend  over 
the  arm,  keeping  the  part  wet  with  lead-water, 
or  even  with  cold  Vv^ater  simply,  will  be  attended 
with  great  advantage.  These^  combined  with 
the  exhibition  of  a  smart  purgative  every  day  or 
iwo,  together  with  abstinence  from  animal  food 

F 


42 

and  ardent  liquors,  will  generally  effect  a  cure 
in  a  short  time,  or  so  far  alleviate  the  violence  of 
the  symptoms,  that  any  common  dressing  will 
suffice. 

The   efflorescence,    as  has  been  observed,  is 
sometimes  accompanied  v^ith  a  very  disagreeable 
itching:  by  bathing  the  part  in  rectified  spirits  of 
wine,  or  ardent  spirits,  this  disagreeable  symp- 
tom is  almost  instantaneously  relieved. 

It  has  been  recommended,  and,  indeed,  prac^ 
tised  by  some,  in  order  to  avoid  the  bad  conse- 
quences arising  from  irritation,  &c.  to  destroy, 
by  means  of  the  sulphuric  acid,  or  some  other 
active  caustic,  the  local  pock,  or  vesicle,  so  soon 
as  it  shall  have  produced  its  desired  effect  on 
the  constitution.  But  the  great  difficulty  in 
establishing  a  specific  time  when  the  disease 
shall  have  succeeded  in  completely  securing  the 
constitution  from  the  influence  of  variolous  in-^ 
fection,  will  ever  render  this  practice  fallacious 
and  delusive. 


Manner  of  preserving  Vaccine  Virus  y  and  Method 
of  Vaccination. 

THE  virus  of  Vaccina  being  naturally  of  a  very 
perishable  nature,  it  is  highly  requisite  that  every 
physician  who  undertakes  to  inoculate  with  it 
should  be  acquainted  with  the  most  effectual 


45 

means  of  preserving  it,  for  the  longest  time,  ifi 
its  most  active  state;  and  more  especially  so  for 
those  that  reside  in  the  country,  where  a  failure 
might  be  with  difficulty  supplied. 

Most  of  the  physicians  who  have  practised 
with  vaccine  virus  have  been  in  the  habit 
of  securing  it  on  the  point  of  a  lancet,  not 
Apprehending  that  the  matter  very  speedily  suf- 
fered a  decomposition  thereby,  from  the  action 
which  it  exerts  on  the  metal  of  the  instrument. 
It  is  well  known,  that  all  fluids  containing  a  por- 
tion of  oxygen  in  their  composition,  on  coming 
in  contact  with  iron  or  steel,  very  readily  undergo 
a  decom.position,  having  the  oxygen  they  hold  as 
a  constituent  part  detached,  and  united  to  the 
metal,  reducing  the  latter  to  the  state  of  an  oxyd; 
v/hich  process,  at  the  same  time  that  it  proves 
destructive  to  the  metal,  also  destroys  the  qua- 
lities of  the  fluid.  It  therefore  necessarily  follows, 
that,  as  the  virus  of  Vaccina^  in  common  Vvdth 
all  other  animal  secretions,  contains  a  quantity 
of  oxygen  in  its  composition,  on  being  subjected 
to  the  same  process,  must  undergo  the  same  or 
similar  changes  of  its  properties,  which  renders 
it  altogether  unfit  for  use,  being  frequently,  if 
used,  productive  of  a  disease  of  a  spurious  nature^, 
the  bad  consequences  of  which  have  been  al- 
ready sufficiently  explained.  In  such  cases  the 
physician  is  not  o'  !y  foiled  in  his  attempt  to 
produce   the  genuine  complaint,  but  is,  at  the 


44 

same  time,  deprived  of  the  use  of  his  instrument; 
for  there  are  very  few  lancets,  after  having  had 
infection  preserved  on  them,  that  are  fit  for  use 
till  after  having  passed  the  hands  of  the  cutler. 
The  consequence  of  such  improper  practice  is, 
that  the  physician  is  continually  labouring  under 
imnecessary  expense,  and  his  own  reputation,  to- 
gether with  that  of  the  disease,  are  both  very 
rnaterially  injured.  The  m.any  difficulties  and 
embarrassments  thus  arising,  are,  I  am  convinced, 
sufficient  to  deter  any  one,  in  future,  from  em- 
ploying similar  means  for  the  preservation  of 
this  precious  fluid. 

Another  method,  which  by  many  has  been  had 

frequent  recourse  to^  is  the  preservation  of  it  on 

cotton  thread.     But  this  mode,  I  am  of  opinion, 

will  be  found  not  sufficiently  economical,  as  h, 

requires  a  large  cjuantity  of  the  virus  properly  to 

imbue  a  small  portion  of  thread.     Besides  the 

foregoing  objection,  another  presents  itself  of  a 

much  more  serious  nature^  which  is,  that  virus 

so  preserved  is  prone  to  run  into  the  putrefactive 

fermentation ;  v/hich  process,  it  is  well  known> 

destroys  the  chemical  combination  of  all  bodies 

subject  to  its  action;  consequently  the  virus,  after 

having  undergone  this  change^  is  entirely  unfit 

for  use. 

Another,  and,  as  appears  to  m.e,  the  most  eli^ 
gible  method  that  has  been  adopted  for  the  pre- 
servation of  the  virus,  is  by  securing  it  between 


45 

pieces  of  glass,  or  upon  pieces  of  quill  made 
pointed  at  the  end  on  which  the  matter  is  to  be 
collected.  When  it  is  to  be  preserved  in  the 
former  way,  common  window  glass  is  to  be  made 
use  of,  previously  cut  into  square  pieces  of  about 
an  inch  each,  so  that  they  shall  be  smooth,  and 
in  exact  contact  with  each  other.  Having  pro- 
perly taken  the  above  precautions,  the  vesicle 
from  whence  the  matter  is  to  be  obtained  must 
be  repeatedly  and  gently  punctured  with  a  sharp 
lancet,  being  cautious,  at  the  same  tim^e,  not  to 
penetrate  too  deep,  otherwise  the  serum  from  the 
adjacent  vessels  is  apt  to  be  effused,  which  very 
frequently  deceives  us,  it  being  impossible  to 
discriminate  this  from  the  real  virus;  very  shortly 
after  which  the  virus  will  begin  gently  to  ooze 
.out  at  each  puncture,  in  form  of  transparent  lim- 
pid drops,  very  much  resembling  those  of  dew^ 
provided  none  of  the  surrounding  blood-vessels 
are  injured  by  the  lancet.  The  matter  thus  col- 
lected round  the  punctures  is  to  be  carefully 
taken  off  on  the  point  of  a  lancet,  or  any  con- 
venient instrument,  and  transferred  to  the  sur- 
face of  one  of  the  plates  of  glass  on  which  it  is 
to  be  preserved;  care  must  be  taken,  at  the  same 
time,  to  confine  it  to  a  small  spot  upon  the 
center  of  the  glass,  about  the  size  of  a  split  pea. 
After  having  been  thus  collected,  it  should  be 
suffered  to  dry  in  the  common  temperature  of  the 
atmosphere,  and  should  then  be  immediately  se- 


4^ 

cured  by  accurately  placing  the  other  bit  cf  gia&5 
over  it,  and  wrapping  thera  up  in  goId-beater^s 
skiU;,  or  a  piece  of  wetted  bladder,  in  order  to 
secure  it  from  the  action  of  the  external  air. 

Many  have  preferred  pieces  of  quill  or  ivory 
for  preserving  the  matter  on;  and,  from  the  very 
little  trouble,  both  in  the  preservation  and  ino- 
culation, with  matter  thus  kept,  I  think  it  much 
the  best  of  any  that  has  been  heretofore  devised; 
nothing  more  being  necessary,  when  this  mode 
is  had  recourse  to,  than  merely  touching  the 
point  of  them  with  the  virus,  and  permitting  it 
to  dry  thereon,  as  above  directed. 

Many  other  means  have  been  used  for  pre- 
serving vaccine  matter.  By  some  it  is  said  to 
retain  its  infectious  power  for  an  unlimited  time, 
if  kept  in  dry  hydrogen  or  nitrogen  gas.  Dr. 
Pearson,  of  London,  has  recommended  the  pre- 
serving it  on  platina  lancets.  But,  whichever  of 
these  ways  is  adhered  to,  it  will  always  be  found 
necessary  entirely  to  seclude  it  from  the  action  of 
air  and  of  light,  it  having  been  lately  discovered 
that  either  of  these  agents  is  capable  of  decom- 
posing it. 

Vaccine  inoculation  has  been  frequently  com- 
plained of,  and  even  objected  to,  by  many,  on 
account  of  its  frequent  failure  in  exciting -the 
complaint.  Upon  accurate  and  impartial  observa- 
tion, however,  it  will  be  discovered,  for  the  most 
part,  to  be  ov/ing  to  mismanagement,  or  inat- 


tention  on  the  part  of  the  physician ^  for  the 
virus  of  Vaccina,  I  believe,  if  the  necessary  pre- 
cautions be  used,  will  take  effect  nineteen  times 
out  of  twenty. 

On  accurately  investigating  the  causes  of  failure 
in  vaccine  inoculation,  we  shall  find  them  prin- 
cipally to  resolve  themselves  into  the  three  fol- 
lowing heads:  1.  From  a  deterioration  of  the 
virus;  2.  From  a  peculiar  disposition  of  habit, 
whereby  it  is  incapacitated  to  receive  the  im- 
pression of  the  disease;  and,  3.  From  the  method 
of  introducing  the  matter. 

The  matter  of  Vaccina  is,  no  doubt,  frequently 
rendered  inert  from  some  peculiar  change  wrought 
on  it  while  contained  in  the  vesicle.  This  change 
may  be  produced  by  some  specific  morbid  action 
of  the  vessels  secreting  it,  which,  as  well  as  being 
endowed  with  the  power  of  elaborating  and  se- 
creting the  most  noxious  poisons,  possess  also  the 
faculty  of  rendering  them  inert  and  harmless- 
That  there  is  a  certain  change  of  the  properties 
of  the  virus  immediately  ensuing  the  formation  of 
the  efflorescence  or  areola,  is  sufficiently  evinced 
from  the  frequent  ineffectual  attempts  to  pro- 
duce the  disease  with  virus  procured  after  that 
period,  and  from  its  almost  uniformly  inducing 
a  spurious  complaint  if  it  takes  effect.  It  is,  in- 
deed, asserted  by  some,  that  matter  taken  at  this 
period  has  been  known  frequently  to  succeed  in 
producing  the  true  disease.     But,  if  we  put  cou> 


48 

iidence  in  what  Dr.  Jenner  says,  It  must  be  al- 
lowed that  such  matter  is  productive  of  a  spu- 
rious complaint,  thereby  frequently  misleading 
the  unwary  and  inexperienced  practitioner.  The 
practice  ought,  therefore,  without  hesitation,  to 
be  abolished  -,  and  matter  should  never  be  used 
after  having,  in  any  degree,  lost  its  original  trans- 
parency or  limpid  consistency;  which  changes 
are  produced  by  other  causes  than  that  of  its 
own  specific  inflammation,  as  the  peculiar  ac- 
tion of  the  vessels,  that  morbid  state  of  them 
immediately  succeeding  to  mechanical  irrita- 
tion, &c.  The  properties  of  the  matter  are 
also  frequently  destroyed  from  not  preserving  it 
on  such  substances  as  are  incapable  of  oxyda- 
tion,  and  from  not  securing  it  properly  from  the 
light. 

All  the  above  circumstances  are  evidently  fre- 
quent sources  of  failure  in  the  new  inoculation. 
Hence  the  most  scrutinizing  and  strict  attention, 
in  regard  to  the  matter  we  make  use  of,  is  re^ 
quisite,  if  we  \vish  to  preserve  sacred  our  own 
reputation  and  that  of  the  disease. 

The  second  cause  of  failure  which  has  been 
mentioned  is  predicated  on  the  opinion  that  the 
system  may,  at  certain  times,  be  so  disposed  as 
to  incapacitate  it  for  the  reception  of  vaccine  im- 
pression. For  the  truth  of  this  position,  no  vac- 
cinator w^ill  require  any  further  evidence  than  a 
reference  to  his  own  practice.     The  same  also 


49 

.Qceurs  in  variolous,  inoculation.  That  there  is  a 
jaatural  tendency  or  disposition  in  the  constitu- 
tion of  some  to  counteract  or  entirely  reject  cer- 
tain morbid  impressions,  is  an  incontrovertible 
fact^  and  that  many  morbid  changes  take  place 
in  the  system,  which  have  the  same  or  similar 
eiFects,  cannot  for  a  moment  be  doubted.  When 
this  incapacity  of  the  system  arises  from  the 
former  of  these,  it  is  probable  that  it  is  occasioned 
by  sorne  peculiar  physical  arrangement  or  con- 
struction of  the  coniponent  particles  of  the  body; 
and  when  from  the  latter,  by  some  morbid  de- 
rangement or  alteration  of  them.  It  sometime^ 
happens  that,  either  from  one  or  other  of  these 
causes,  the  matter,  after  having  been  inserted 
under  the  cuticle,  shall  remain  in  a  dormant  or 
inactive  state  for  several  days,  frequently  not 
]ess  than  ten  or  fifteen,  not  even  exhibiting,  all 
this  time,  the  slightest  grade  of  inflarnmation, 
several  instances  of  which  are  related  in  a  former 
part  of  this  dissertation. 

There  was  once  a  case  of  Cow-pock  came 
under  my  observation,  in  which  the  efflorescence 
was  entirely  suspended  for  several  days  beyond 
its  usual  time  of  appearance,  by  the  supervention 
of  measles. 

The  last,  and  which  is  certainly  not  an  unfre= 
quent  source  of  failure,  I  have  noticed  as  arising 
from  the  method  of  introducing  the  virus.  If, 
at  the  time  of  inoculation,  there  happens  to  be 

G 


50 

much  mechanical  irritation  occasioned  by  intro^ 
ducing  the  matter,  the  part  becomes  prematurely- 
inflamed  3  and  this  inflammation  being  of  a  totally 
different  nature  from  that  induced  by  the  matter 
itself,  the  effects  of  the  latter  are  entirely  coun- 
teracted, notwithstanding  it  be  ever  so  genuine. 
This  same  cause,  very  often  also,  produces  a  fai- 
lure, v^hen,  from  the  w^ant  of  fresh  matter,  we  are 
under  the  necessity  of  using  such  as  has  been 
preserved  on  cotton.  In  such  cases  the  portion 
of  thread  introduced  acts  as  an  extraneous  body, 
giving  rise  to  an  issue.  Premature  inflammation 
affords  us  a  criterion,  whereby  we  can  generally, 
with  a  great  degree  of  certainty,  judge  of  the 
success  of  the  operation,  and  of  the  nature  of 
the  disease  induced. 

From  what  has  been  above  adduced,  the  foU 
lowing  very  useful  deductions  naturally  arise. 

1.  That  vaccine  virus,  either  for  inoculation 
or  preservation,  should  always  be  taken  pre- 
vious to  the  formation  of  the  efflorescence  or 
areola. 

2.  That  we  should  always  make  use  of  the 
most  recent  matter  that  can  be  obtained  3  and, 
provided  it  be  impracticable  to  procure  it  imme- 
diately from  the  vesicle,  we  should  prefer  such  as 
has  been  preserved  on  those  substances  that  are 
incapable  of  oxydation. 

3.  That  as  little  irritation  should  be  made  use 
of,  in  its  introduction,  as  can  be  dispensed  with, 


5i 

This,  indeed,  may  be  very  little,  as  it  is  never 
iiecessary  to  draw^  blood. 

As  it  respects  the  mode  of  vaccine  inocula^ 
tion,  there  are  but  two  principal  ways  that  are 
at  present  practised;  namely,  by  puncture  and 
incision. 

The  former  of  these  methods  I  deem  prefer- 
able in  all  cases,  except  where  an  infected  thread 
is  used,  and  even  here,  I  believe,  it  is  more  apt 
to  succeed  than  incision.  Whichever  of  the 
ways  be  made  use  of,  it  is  necessary  for  us,  in 
the  first  place,  to  provide  ourselves  with  a  sharp 
and  clean  lancet,  being  cautious,  by  all  means, 
not  to  use  one  that  has  been  previously  armed  with 
variolous  virus  j  for  very  unpleasant  consequences 
have  not  unfrequently  followed  such  improper 
conduct.  In  making  the  puncture  or  incision, 
we  should  endeavour,  as  much  as  possible,  to 
avoid  drawing  blood,  for  if  we  do,  the  operation 
will  be  less  likely  to  succeed,  as  the  blood,  most 
probably,  washes  away  the  virus^  After  having 
made  the  puncture  or  incision,  and  carefully  in- 
troduced the  matter,  a  piece  of  court  or  adhesive 
plaster  should  be  applied  immediately  over  the 
place,  as  it  gives  to  the  operation  greater  surety 
of  success.  But,  whether  it  arises  wholly  from 
restraining  the  subsequent  hemorrhage,  or  in 
part  from  preventing  the  evaporation  of  the  more 
volatile  and  active  properties  of  the  matter,  I  do 
not  know;  but  probably  from  both. 


s 


There  should  also  be  a  preference  as  to  tti^ 
|)lace  of  inoculation.  The  part  of  the  arm,  ^bout 
half  way  between  the  shoulder  and  elbow,  near 
the  insertion  of  the  deltoid  niuscle,  is  that  which 
is  pretty  generally  preferred  zt  present;  and^ 
from  its  being  less  exposed  to  the  atmosphere^ 
from  there  not  being  any  joints  or  tendons  in  the 
neighbourhood,  and  from  its  being  less  liable 
to  injury  than  almost  any  other  part  of  the  body^ 
I  conceive  it  to  be  by  far  the  most  proper  for 
the  purpose^ 


A  Consideration  of  the  Manner  in  tvhkh  Vaccine 
Virus  acts  on  the  Human  Constitution,  and  of 
the  Effects  it  produces. 

IT  has  long  been  laid  dovvn  as  an  incontro- 
vertible fact  in  medicine,  that  whatever  is  ap* 
plied  either  to  the  cuticular,  pulmonary,  or  in^ 
testinal  surfaces,  must^  in  order  to  produce  its 
operation  on  the  system,  be  taken  up  by  the  ab- 
sorbents, and  conveyed  into  the  circulatory  mass 
of  fluids,  v/hether  of  a  bland  nutritious  nature^ 
or  a  violent  corrosive  poison.  It  is  even  sup^ 
posed,  by  our  best  physiologists  and  physicians, 
that  this  is  the  only  rational  manner  of  account- 
ing for  the  operation  of  the  most  noxious  agents^ 
and,  in  short,  of  almost  every  medicine  the 
Materia  Medica  affords. 


5$ 

This,  however.  Is  a  doctrine  which  I  cannot, 
at  present,  accede  to,  and  one,  the  truth  of 
which  I  have  for  a  long  time  doubted,  as  it 
does  not  appear  to  nae  possible  that  any  such 
noxious  or  extraneous  bodies  could  be  received 
into  so  pure,  uncontaminated,  and  mild  a  fluid 
as  the  blood,  which  is  intended  solely  for  the 
nourishment  and  warmth  of  the  bodv,  without 
occasioning  instantaneous  death,  or,  at  least, 
without  producing  the  most  terrible  commotion 
and  derangement  of  the  system. 

It  is  said  that  the  small-pox  matter,  after  its 
introduction  under  the  cuticle,  is  taken  up  and 
conveyed  into  the  circulation  through  the  medium 
of  the  absorbents.  If  this  be  the  case,  the  mat- 
ter must,  of  course,  undergo  the  round  of  cir= 
culation;  consequently,  owing  to  its  stimulating 
and  poisonous  qualities,  the  system  must  be  ex- 
cited into  m.orbid  or  increased  action,  which  ac- 
tion, it  is  said,  tends  to  throw  out  the  matter  on 
the  surface  of  the  body,  in  form  of  eruptions. 

Now,  in  order  to  prove  the  fallacy  of  this  doc- 
trine, it  is  only  necessary  to  observe,  that  if  it 
were  a  mere  expulsion  of  the  matter  absorbed, 
there  could  not  possibly  be  so  large  a  quantity 
thrown  out  on  the  skin  as,  in  many  instances'/ 
there  actually  is;  for  the  quantity  inserted  at  the 
time  of  inoculation  is  known  to  every  one  to  be 
in  proportion  infinitely  small.  Whence,  then, 
is  the  source  of  this  large  quantity  of  matter?: 


54 

Surely,  it  would  be  very  preposterous  to  suppose 
that  the  small  particle  which  enters  the  circula- 
tion has  the  power  of  producing  so  large  a  quan- 
tity, by  assimilating  the  blood  to  its  own  nature. 

Again :  it  is  supposed,  by  many,  that  the 
matter  entering  the  circulation  is  not  directly 
expelled  from  the  system ;  but  that,  in  conse- 
quence of  certain  peculiar  inherent  properties, 
it  is  capable  of  exciting  a  specific  morbid  action 
of  the  sanguiferous  system ;  and  that  this  specific 
action  disposes  the  secerning  vessels  of  the  skin 
to  take  on  tlie  office  of  secreting  variolous  mat- 
ter. This,  it  is  true,  appears  to  be  a  much  more 
plausible  theory  than  the  former ;  but  it  is,  I  am 
persuaded,  not  without  many  insurmountable 
difficulties.  By  this  mode  of  reasoning  it  is  im- 
possible to  account  for  the  long-continued  circu- 
lation, and  consequent  application  of  the  matter 
to  the  internal  surface  of  the  arterial,  venous 
and  absorbent  systems,  without  producing  a 
more  immediate  effect;  it  being  uniformly  found 
that  it  is  several  days  after  inoculation  before 
any  symptom  of  the  complaint  becomes  appa- 
rent. If,  upon  its  introduction,  it  were  imme- 
diately taken  up  by  the  absorbents,  it  must  ne- 
cessarily, in  a  very  short  time,  pass  into  the  cir- 
culation. Perhaps,  however,  this  may  be  an- 
swered by  some,  in  saying  that  it  remains  in  the 
place  where  it  was  first  inserted,  until,  by  its 
irritation,  it  shall  have  excited  the  vessels  of  this 


55 

local  part  to  secrete  a  certain  quantity  of  virus; 
and  that  it  is  then  absorbed,  and  produces  all 
the  subsequent  phenomena.  But,  that  so  acrid 
and  irritating  a  poison  as  this  should  so  long  re- 
main in  contact  with  the  tender  and  patulous 
mouths  of  the  absorbents,  and  should  then  be 
taken  up  by  them,  seems  quite  paradoxical.  I 
should  rather  be  inclined  to  suppose,  that,  after 
it  had  induced  this  degree  of  morbid  excitement 
on  their  sensible  extremities,  it  would  be  rejected 
by  them,  instead  of  being  absorbed. 

Again  :  that  so  small  a  particle  of  matter  as  is 
sufficient  to  produce  Vaccina  or  small-pox  should 
be  so  infinitely  divided  as  to  be  applied  to  the 
internal  surface  of  the  heart,  arteries,  and  all  the 
ramifications  of  the  sanguiferous  system,  so  as  to 
produce  all  the  violent  symptoms  and  phenomena 
attendant  on  these  diseases, particularly  small-pox, 
appears  to  me  quite  impossible.  If  this  theory  be 
true,  we  must  admit  that  of  the  divisibility  of 
matter  ad  hifinitum;  for,  if  this  be  the  fact,  a  par- 
ticle of  the  virus  must  necessarily  be  applied  to 
every  portion  or  particle  of  matter  entering  into 
the  constitution  of  the  animal  economy;  which 
theory,  however  clearly  it  may  be  proved  by 
mathematical  demonstration,  is,  in  a  physical 
sense,  altogether  incorrect  and  absurd.  I  can- 
not, indeed,  suppose  it  possible,  that  the  matter 
should  so  long  remain  in  the  circulatory  mass  of 
fluids,  without  producing  som.e  sensible  change 


56 

in  the  functions  of  the  system.  And  how  it 
should  happen  that  any  thing  should  pass  through 
the  absorbents  into  the  circulation,  in  propria 
formay  is  impossible  for  me  to  conceive;  it  being 
a  fixed  law  in  physiology^  I  l^elieve,  that  no- 
thing is  capable  of  entering  or  passing  through 
the  vessels  of  the  human  body,  without  having 
first  undergone  an  appropriate  change,  by  the  in- 
fluence of  living  vascular  action;  or,  in  other 
words,  not  without  having  been  animalized,  or 
assimilated  to  the  nature  of  the  body.  By  the 
agency  of  this  peculiar  action  of  parts,  are  all 
the  different  secretions  to  be  accounted  for:  and 
upon  what  other  principle  than  vascular  influence 
or  action  is  the  formation  of  the  blood  itself  to 
be  explained?  Further,  it  does  not  appear  to 
me  reasonable  to  suppose,  that  a  chemical  agent, 
so  much  disposed  to  act  upon  bodies,  and  so 
liable  to  be  acted  on  and  decomposed  by  other 
chemical  bodies,  as  vaccine  or  variolous  matter, 
should  exist  in  contact  with  such  a  combination 
of  chemical  agents  as  the  blood  and  other  parts 
of  the  system,  without  undergoing  the  common 
effect  of  all  such  bodies.  Is  it  not  highly  probable 
that  the  portion  of  ferruginous  matt'er  existing 
in  the  blood  would  as  soon  destroy  the  activity 
of  the  virus  while  in,  as  out  of  the  system  ?  It 
is  well  known  that  vaccine,  together  with  vario^ 
lous,  and  all  other  morbid  poisons,  being  by  any 
means  deprived  of  their  oxygen,  become  entirely 


inert  and  harmless.  If,  therefore,  the  activit)? 
of  vaccine  and  variolous  matter  depend,  in  so 
intimate  a  manner,  on  the  existence  of  oxygen 
in  their  composition,  it  clearly  follows,  that,  in 
passing  the  routine  of  circulation,  they  must  lose 
their  effects,  as  they  there  meet  v^ath  numerous 
substances  capable  of  depriving  them  of  this 
principle.  From  whence,  then,  can  we  derive 
support  for  the  theory  of  absorption? 

If  it  be  true  that  the  matter  of  Vaccina  must, 
in  order  to  produce  the  disease,  be  absorbed, 
and  pass  through  the  circulating  mass  of  fluids, 
why  are  its  effects  in  so  great  a  measure  concen- 
trated in  the  place  of  inoculation,  and  how  comes 
it  that  there  are  not  eruptions  on  the  surface? 

The  above  facts  and  observations  are  sufiicient, 
I  am  persuaded,  to  expose  the  fallacy  of  the 
doctrine  of  absorption,  that  is,  as  respects  the 
action  of  vaccine  and  variolous  virus.  I  shall 
now,  in  as  concise  and  comprehensive  a  manner 
as  I  am  able,  lay  before  the  reader  my  own  opi- 
nion on  the  subject. 

I  believe  it  is  a  well  established  and  almost 
universally  admitted  fact  in  physiology,  that  there 
is  a  remarkable  and  intimate  connection,  or  sym- 
pathy, existing  between  the  surface  of  the  body 
and  the  stomach.  This  is,  indeed,  proven  by 
every  day's  experience.  It  has  been  observed,  by 
a  very  learned  and  sagacious  physician,  that  the 
skin  niight  very  properly  be  considered  a  kind 

H 


58 

of  second  stomach,  through  the  medium  of  which 
we  are  enabled  to  communicate  to  the  system 
the  effect  or  influence  of  almost  every  article  in 
medicine;  and  that,  in  time,  it  would  probably 
supersede  the  necessity  of  the  internal  exhibition 
of  very  many  nauseous  and  disagreeable  reme- 
dies. Modern  practice  teaches  us,  that  opium, 
^camphor,  nicotiana,  mercury,  emetic  tartar,  tere- 
binthina^and  many  other  medicines,  prove  equally 
effectual  w^hen  applied  to  the  surface  as  when  ta- 
ken internally.  Hence  we  see  that  we  are  enabled 
to  purge,  salivate,  puke  and  sweat,  by  this  mode 
of  administering  medicines.  No  one,  I  appre- 
hend, will  attempt  to  explain  the  effects  of  these 
medicines,  when  applied  in  this  manner,  upon 
any  other  principle  or  theory  than  that  of  sym- 
pathetic association.  If  this  be  the  manner  in 
which  medicines,  when  so  applied,  operate  on 
the  system,  are  we  not,  by  analogical  reasoning,, 
irresistibly  led  to  conclude,  that  all  morbid  poi- 
sons produce  their  effects  in  the  same  identical 
way?     Most  clearly  we  are. 

The  interval  of  time  that  takes  place  between 
the  introduction  of  the  virus,  and  the  coming 
on  of  the  constitutional  symptoms,  is  very  satis- 
factorily explained  by  this  consent  of  parts,  but 
not  by  absorption.  The  manner  in  which  this 
circumstance  is  explained,  by  the  former  of  these, 
is,  that  the  morbid  topical  action,  induced  by  the 
virus  at  the  place  of  inoculation^  requires  a  cer- 


59 

tarn  time  to  accumulate  sufficient  force  to  affect 
the  stomach;  and  the  stomach,  after  having  re* 
ceived  this  impression  by  sympathizing  with  the 
skin  of  the  arm,  affects  the  heart  and  arteries,  by 
their  secondarily  sympathizing  with  this  organ, 
producing  all  the  phenomena  of  the  concomitant 
fever,  which  is  always  in  direct  ratio  with  the  de- 
rangement of  this  viscus.  And  from  the  ready 
sympathy  of  the  stomach  in  some  instances,  and 
in  some  particular  idiosyncrasies,  are  the  varieties 
and  different  degrees  of  violence  of  the  com- 
plaint to  be  explained.  The  eruptions  in  the 
small-pox  are  explained  in  this  way :  that  the 
variolous  virus,  from  its  producing,  by  the  consent 
of  parts,  a  peculiar  or  specific  irritation  on  the 
heart  and  arteries,  the  secerning  vessels  of  the  skin 
are  thereby  induced  to  assume  that  particular  spe- 
cies of  action  which  affords  the  secretion  of  va- 
riolous matter.  Are  not  the  operation  of  all  mor- 
bid poisons  much  more  rationally  explained  upon 
the  principles  of  this  theory  than  upon  those  o£ 
absorption?  And  have  we  not  reason  to  anti- 
cipate the  explanation  of  the  operation  of  all 
medicines  upon  the  same  principle?  Certainly, 
the  operation  of  opium,  bark,  wine,  volatile 
alkali,  arsenic,  and  a  number  of  others,  as  be- 
fore mentioned,  are  only  explicable  in  this  way. 

Another  fact,  which  very  much  invalidates 
the  theory  of  absorption,  is,  that  Dr.  Physick, 
of  Philadelphia,  has  proved,  by  various  experi- 


m 

iiiehts,  that  mercury,  when  administered  for  the 
cure  of  syphilis,  does  not  enter  into  the  circula- 
tion. 

The  antagonists  of  the  sympathetic  theory  m_ay 
probably  urge  this  objection — that  if  the  chyle  is 
taken  up  by  the  lacteals,  medicines,  in  conse- 
quence of  their  being  taken  into  the  stomach, 
and  actually  mixed  with  this  fluid,  must  also  be 
taken  up  at  the  same  tinle.  But  the  advocates 
of  this  opinion  will  do  well  to  recollect,  that 
the  chyle  is  a  bland,  innocuous  fluid,  intended 
solely  for  the  nourishment  and  support  of  th^ 
system; 

Now,  if  this  be  the  use  to  which  the  chyle  is 
destined,  it  is  clear  that,  if  it  carried  along  with 
it  all  the  irritating  and  poisonous  substances 
taken  into  the  stoniach,  it  would  certainly  be 
very  far  from  answering  this  purpose.  Neither 
does  it  appear  to  me  reasonable  to  suppose, 
that  nature  ever  intended  the  lacteals,  or  any 
part  of  the  absorbent  system,  to  take  up  or  con- 
vey any  thing  but  their  own  appropriate  fluids. 
If  they  should,  it  would  be  contrary  to  the 
laws  of  physiology,  to  suppose  that  such  sub- 
stances should  pass  on  through  them  in  propria 
forma.  I  believe  it  is  alniost  uiiiversally  admitted, 
that  the  vessels  themselves,  by  their  own  speci- 
fic actions,  form,  or  secrete  the  fluids  which  they 
convey;  consequently,  if  there  ever  is  any  thing 
Absorbed  or  taken  up  by  them,  it  must  neces- 


61 

sarily  undergo  that  peculiar  change,  in  ordeY 
that  it  may  pass  on  through  them.  Further:  if 
every  thing  that  passes  into  the  stomach  and  in- 
testines was  as  readily  absorhed  and  carried  into 
the  circulation  as  the  chyle,  the  blood  must  ne- 
cessarily, in  a  very  short  time,  become  one  of 
the  most  heterogeneous  and  contaminated  fluids 
in  nature.  Bat,  contrary  to  all  this,  we  find  it 
to  be  one  of  the  most  mild,  salutary,  and  nutri- 
tious; composed  invariably  of  a  certain  number 
of  constituent  parts;  never  varying,  either  in 
health  or  disease,  except  in  its  consistency  and  the 
relative  proportion  of  its  constituent  principles. 
Again:  if  things  were  absorbed  and  carried  into 
the  blood,  we  should  certainly  be  enabled,  by 
experiments,  to  discover  them;  but  notwith- 
standino^  the  vast  number  that  have  been  insti- 
tuted  for  this  purpose,  not  the  least  particle  of 
extraneous  matter  has  ever  been  detected  in  it. 

To  conclude  this  subject,  I  would  beg  leave 
to  ask  the  advocates  for  absorption,  whether  it 
appears  in  any  w^ay  probable,  or  even  possible, 
agreeable  to  the  laws  of  chemistry,  that  a  sub- 
stance should  remain,  for  any  length  of  time, 
in  so  powerful  a  solvent  and  chemical  agent  as 
the  gastric  juice,  without  having  wrought  upon 
it  some  particular  change  ? 

If  the  doctrine  of  sympathy,  nervous  con- 
sent, or  associated  motion,  whichever  you  may 
please  to  term  it,  explains,  in  a  satisfactory  and 


^2 

rational  manner,  all  the  phenomena,  and  if  the 
data  upon  which  it  is  predicated  be  just,  upon 
the  principles  of  philosophical  induction,  it  is 
certainly  right  to  give  this  the  preference  to  all 
others. 

Much  more  might  easily  be  adduced  in  sup- 
port of  this  theory,  but  the  limits  which  I  have 
prescribed  to  this  Dissertation  will  not  permit. 

To  many  it  may  appear  an  act  of  supereroga* 
tion  to  offer  any  thing  further  respecting  the  be- 
neficial effects  of  Vaccina.  But  the  very  illibe- 
ral conduct  and  groundless  opposition  inculcated 
and  persisted  in  by  many,  induces  me  to  make 
the  following  observations. 

The  first  and  most  imiportant  advantage  of 
Vaccine  inoculation  is,  that  those  persons  who 
have  once  regularly  and  truly  passed  through  the 
disease  are  rendered  thereby  for  ever  after  un- 
susceptible of  the  small-pox,  either  by  inocula- 
tion or  contagion.  In  proof  of  this  assertion  I 
might  adduce  numerous  instances,  upon  the  re- 
spectable authorities  of  Jenner,Ring,  Aikin,Pear- 
'son,  and  many  others  w^ho  have  written  on  the 
subject,  of  persons  remaining  completely  secure 
from  the  attack  of  small-pox,  for  ten,  twenty, 
thirty,  forty,  fifty,  and  even  sixty  years,  after 
having  been  infected  with  Cow-pock:  but,  in 
order  to  save  time,  I  shall  beg  leave  to  refer  any 
person  desirous  of  becoming  more  particularly 
informed  on  the  subject,  to  the  authors  I  have 


63 

quoted,  and  also  to  the  Medical  and  Physical 
Journal  of  London,  and  to  the  Medical  Reposi- 
tory of  New- York,  where  he  will  find  a  detail  of 
almost  every  thing  that  has  transpired  on  the 
subject.  Of  its  protecting  the  system  for  one, 
two,  and  even  three  years,  against  the  effects 
of  small-pox,  we  have  numerous  instances  in 
our  own  city. 

During  my  stay  at  the  New-York  Kine-pock 
Institution,  about  one  hundred  and  twenty  or 
thirty  patients,  as  before  stated,  were  inoculated 
with  Cow-pock,  ten  of  which  number,  at  the 
request  of  the  Medical  Board,  I,  at  the  expira- 
tion of  the  year,  tested  with  the  most  active  and 
recent  small-pox  matter  I  could  procure.  The 
virus  alluded  to  was  taken  from  the  pustules  of 
a  person  labouring  under  a  very  full  burthen  of 
them  in  the  natural  way;  a  sufficient  quantity  of 
which,  in  the  course  of  half  an  hour  after  it  was 
procured,  was  carefully  inserted  into  both  arms  of 
every  one  of  the  ten ;  but  they  uniformly  resisted 
it;  none  of  their  inoculations  exhibiting  any 
other  appearance  of  their  having  succeeded  than 
a  small  red  pimple,  (and  many  of  them  not  even 
this)  which,  as  is  usual  in  such  cases,  altogether 
disappeared,  in  a  very  short  time,  without  the 
least  symptom  of  small-pox.  Several  of  the  other 
patients  have  informed  me  that,  since  they  had 
undergone  vaccination,  they  had  been  repeatedly 
exposed  to  variolous  contagion^,  in  its  most  viru- 


64 

lent  and  concentrated  form,  but  without  the  least 
effect.  One  of  them  told  me,  some  time  in 
May  last,  that  he  had  slept,  for  several  nights 
successively,  in  the  same  bed  with  a  person  who 
was  labouring  under  the  small-po^  in  the  natural 
way,  of  a  most  malignant  type,  but  had  never 
experienced  any  inconvenience  from  it.  The 
inflammation  excited  by  the  virus,  in  the  cases 
above  stated,  is  an  undoubted  proof  of  its  ac- 
tivity. 

Dr.  Seaman,  of  this  city,  having  very  politely 
favoured  me  with  the  perusal  of  his  official  re- 
gister, I  am  enabled,  by  his  consent,  to  exhibit 
a  statement  of  the  number  he  has  inoculated, 
and  of  the  success  he  has  met  with.  It  appears 
that  the  number  inoculated  by  him  amounts  to 
two  hundred  and  forty-two,  (/.  e,  from  the  22d 
of  May,  1801,  till  the  31st  of  August,  1802) 
of  which  iifty-'eight  have  since  undergone  va- 
riolous inoculation,  some  of  them  repeatedly, 
but  all  with  that  uniform  resistance  that  is  ever 
consequent  upon  real  Vaccina.  It  may,  perhaps, 
be  of  importance  to  observe,  that  two  of  the 
number  were  taken  into  a  room  where  a  person 
was  labouring  under  the  casual  sraall-pox,  of  a 
very  malignant  type,  and  were  exposed  to  it  in 
every  way  that  could  be  devised:  the  pillow-case, 
which  was  so  stiff  with  matter  as  nearly  to  stand 
erect,  was  even  taken  from  under  the  head  of  thQ 
infected  person,  warmed  by  the  fire,  and  hel4 


63 

under  their  noses  ^  and  they  were  made  to  put 
their  hands  into  the  bed  to  him,  but  all  without 
effect.  Such  well  authenticated  cases  as  these,  to 
which  might  be  added  a  thousand  more,  equally 
Well  attested,  must  certainly  be  sufficient  to  carry 
full  conviction  to  the  most  prejudiced  mind. 

To  the  prophylactic  virtue  of  Vaccina  may  be 
added  another  of  almost  equal  importance :  I 
mean  its  salutary  and  effectual  influence  in  the 
removal  of  many  inveterate  and  disagreeable 
complaints.  It  is  alleged  by  Dr.  John  Redmari 
Coxe,  of  Philadelphia,  and  by  many  of  the  most 
eminent  vaccinators  in  Europe,  that  children  of 
weakly  and  debilitated  constitutions  frequently 
have  their  health  amazingly  improved  by  passing 
through  the  Cow-pock;  so  much  so,  in  many 
instances,  as  to  acquire  a  healthy  and  robust 
habit  in  a  very  short  time. 

In  Duncan's  Annals  of  Medicine,  vol.  i.  lus- 
trum 2,  p.  327,  there  is  a  case  related  of  a  very 
singular  chronical  affection  of  the  arm,  which^ 
after  a  lengthy  and  ineffectual  treatment,  with 
all  the  various  medicines  that  could  be  devised^ 
was,  in  a  very  short  time,  completely  cured  by 
inoculation  v/ith  Vaccina. 

In  Turkey  it  is  said  to  have  proved  effectual 
in  securing  persons  from  the  plague. 

In  France  (as  mentioned  in  a  former  part  of 
this  dissertation)  it  has  been  successfully  practised 
in  preventing  the  rot  in  sheep:  and  it  is  sup? 

I  ' 


m 

posed,  by  Dr.  Jenner,  to  produce  a  disease  in 
the  canine  species,  which  renders  them  unsus- 
ceptible of  hydrophobia.  If  this  latter  be  the 
case,  does  not  analogical  reasoning  lead  us  to 
the  conclusion,  that  it  may  be  productive  of  the 
same,  happy  effect  in  the  human  species  ? 

These,  it  appears,  are  the  great  and  import- 
ant advantages  arising  from  the  mild  and  benig- 
nant effects  of  Vaccina,  which,  in  addition  to  its 
gentle  aspect,  unites  the  double  advantage  of 
giving  to  the  system,  security  against  that  deadly- 
foe,  the  small-pox,  and  of  removing  from  it  miany 
obstinate  diseases :  while  the  small-pox,  on  the 
contrary,  although  it  is,  by  the  present  improved 
mode  of  inoculation,  in  a  great  measure  disarmed 
of  its  terrors,  in  some  instances  proves  fatal. 
And  although  fewer  deaths  happen  in  an  equal 
number  of  persons  who  undergo  the  small-pox 
now  than  formerly,  yet  it  must  be  admitted  that 
the  general  prevalence  of  inoculation  tends  to 
spread  and  multiply  the  disease  itself;  of  which, 
though  its  violence  be  miUch  abated  by  the  mo- 
dern mode  of  treatment,  the  contagious  quality 
remains  in  full  force. 

It  deserves  also  to  be  noticed,  that  notwith- 
standing the  fatality  of  the  small-pox  is  very 
much  lessened  by  the  improvement  in  modern 
inoculation,  the  deaths  induced  by  it  are  not  in- 
considerable :  they  are  estimated  at  about  one  in 
every  three  hundred  throughout  England,  and  at 


67 

about  one  in  every  hundred  in  London;  while 
the  loss  in  the  natural  small-pox  is  probably  not 
less  than  one  in  six.  The  same,  no  doubt,  will 
apply  in  this  country.  It  has  been  ascertained, 
by  calculation,  that  not  less  than  forty  millions 
of  the  human  species  fall  victims  to  the  fatal  ra- 
vages of  this  disease  in  every  century ! 

It  has  been  asserted  by  many,  that  although 
Vaccina,  when  conducted  by  skilful  persons,  may 
prove  efficacious  in  shielding  the  constitution 
against  the  small-pox,  its  advantages  over  the  lat- 
ter were  much  depreciated  on  taking  into  conside- 
ration the  vast  number  of  accidents  and  mistakes 
that  are  liable  to  happen  in  it  before  the  world 
shall  have  become  sufficiently  acquainted  with  its 
general  laws.  And  they  have  from  hence  con- 
cluded, that  the  Cow-pock,  in  the  aggregate,  was 
rather  an  evil  than  a  benefit  to  mankind.  This, 
however,  is  a  very  flimsy  pretext,  for  it  is  certainly 
much  better  to  submit  to  temporary  inconveni- 
ence than  to  be  for  ever  afflicted  with  such  a 
destructive  evil  as  the  small-pox.  Nor  ought  it 
to  be  overlooked,  that  mistakes  have  frequently 
occurred  in  the  inoculated  variola ;  and  instances 
are  not  wanting,  in  which  persons  supposed  to 
have  passed  through  it  by  inoculation,  have 
caught  it  afterw^ards  in  the  natural  way.  Several 
such  cases  I  myself  have  witnessed. 

To  the  fatality  of  the  small-pox  may  be  added 
the  many  irremediable  affections  which  it  fre- 


(jiiently  leaves  behind  it  in  the  system ;  as 
lameness,  blindness,  deafness,  &;c.  It  must 
be  known  to  every  experienced  inoculator^ 
that  small-pox  also  calls  into  action  the  latent 
seeds  of  scrophula  and  other  strumous  com- 
plaints, of  which  there  are  many  cases  on  record. 
Another,  and  which  is  considered  by  many  as  an 
imaginary  evil  of  this  disease,  is  the  deformity 
of  the  skin  which  it  frequently  induces,  eveii 
iinder  the  inoculated  form.  In  the  view  of  phi- 
losophy and  reason,  this  may  indeed  be  said  to 
he  an  imaginary  evil,  unworthy  of  regard:  but^ 
imtil  the  world  shall  become  peopled  with  phi- 
losophers and  wise  men,  mankind  will  shudder 
at  the  contemplation  of  a  disease  Vv^hich  robs  the 
most  lovely  part  of  creation  of  all  their  beauty. 

Another  important  advantage  which  Vaccina 
possesses  over  the  small-pox,  is  its  non-contagious 
quality,  being  communicable  in  no  other  way 
than  by  inoculation,  or  an  absolute  insertion  of 
the  matter  under  the  cuticle.  Children  that  have 
hever  had  the  complaint  may  even  sleep  in  the 
same  bed  with  those  that  are  infected  with  it> 
without  experiencing  the  least  inconvenience. 

Why,  then,  upon  an  appreciation  of  all  these 
important  advantages  of  Vaccina,  is  the  public 
mind  so  indifferent  to  its  propagation?  It  is  said 
that,  in  Sicily,  it  is  received  with  enthusiasm^ 
and  that  an  hospital  has  been  already  established, 
by  his  Sicilian  Majesty,    for  the  inoculation  of 


m 

tlie  poor.  Institutions  of  a  similar  nature  have 
been  established  at  Malta  and  Naples ;  and  we 
are  informed  that  vaccine  inoculation  has  been 
adopted  throughout  the  papal  dominions,  in  the 
kingdom  of  Etruria,  and  in  the  Ligurian  Republic. 
Is  it  not  surprising  that  the  magistrates  and 
rulers  of  more  enlightened  nations  do  not  follow 
their  laudable  example  ?  Its  progress,  however, 
like  that  of  all  other  innovations,  though  ever 
^o  well  founded,  must  be  slow,  Vv^hen  the  pre- 
judices and  prepossessions  of  the  public  are  to 
be  contended  with.  It  is,  nevertheless,  esta- 
blished upon  the  broad  and  immutable  basis  of 
truth,  which^  firm  as  the  Newtonian  rock,  will 
remain  unshaken  amidst  the  waste  of  ages;  and 
the  superstructure  erected  thereon  will  afford  an 
asylum  of  protection,  by  recourse  to  which  man- 
kind will  be  enabled  to  rid  themselves  of  a 
monster ! 


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